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Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience

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Abstract

Background

Since the introduction of laparoscopic cholecystectomy (LC), there has been continued evolution in technique, instrumentation and postoperative management. With increased experience, LC has migrated to the outpatient setting. We asked whether increased availability and experience has impacted incidence of and indications for LC.

Methods

The New York (NY) State Planning and Research Cooperative System longitudinal administrative database was utilized to identify patients who underwent cholecystectomy between 1995 and 2013. ICD-9 and CPT procedure codes were extracted corresponding to laparoscopic and open cholecystectomy and the associated primary diagnostic codes. Data were analyzed as relative change in incidence (normalized to 1000 LC patients) for respective diagnoses.

Results

From 1995 to 2013, 711,406 cholecystectomies were performed in NY State: 637,308 (89.58 %) laparoscopic. The overall frequency of cholecystectomy did not increase (1.23 % increase with a commensurate population increase of 6.32 %). Indications for LC during this time were: 72.81 % for calculous cholecystitis (n = 464,032), 4.88 % for biliary colic (n = 31,124), 8.98 % for acalculous cholecystitis (n = 57,205), 3.01 % for gallstone pancreatitis (n = 19,193), and 1.59 % for biliary dyskinesia (n = 10,110). The incidence of calculous cholecystitis declined (−20.09 %, p < 0.0001) between 1995 and 2013; meanwhile, other diagnoses increased in incidence: biliary colic (+54.96 %, p = 0.0013), acalculous cholecystitis (+94.24 %, p < 0.0001), gallstone pancreatitis (+107.48 %, p < 0.0001), and biliary dyskinesia (+331.74 %, p < 0.0001). Outpatient LC incidence catapulted to 48.59 % in 2013, from 0.15 % in 1995, increasing >320-fold. Analysis of LC through 2014 revealed increasing rates of digestive, infectious, respiratory, and renal complications, with overall cholecystectomy complication rates of 9.29 %.

Conclusion

A shifting distribution of operative indications and increasing rates of complications should prompt careful consideration prior to surgery for benign biliary disease. For what is a common procedure, LC carries substantial risk of complications, thus requiring the patient to be an active participant and to share in the decision-making process.

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Acknowledgments

We would like to acknowledge statistical consultation and support from the Biostatistical Consulting Core at the School of Medicine, Stony Brook University. Additionally, we would also like to acknowledge input and guidance in study planning from Stony Brook University’s Surgical Outcome Analysis Research (SOAR) Collaborative.

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Correspondence to Vamsi V. Alli.

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Disclosures

Drs. Vamsi Alli, Jie Yang, Andrew Bates, and Mark Talamini and Ms. Jianjin Xu have no conflicts of interest. Dr. Aurora Pryor serves as a consultant for Apollo, Intuitive and Freehold Medical, is an investigator with Baronova and Obalon, and serves as a speaker for Ethicon and Gore. Dr. Dana Telem serves as a consultant for Medtronic, Gore and Ethicon and receives research support from Cook and Surgiquest.

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Alli, V.V., Yang, J., Xu, J. et al. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc 31, 1651–1658 (2017). https://doi.org/10.1007/s00464-016-5154-9

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