A multidisciplinary team from Scotland and England assessed the effect of the introduction of laparoscopic cholecystectomy on surgical outcomes in routine practice.
Hospital discharge and death-certificate data were linked for all patients undergoing cholecystectomy (n=85120) in Scottish public-sector hospitals (n=51), between January 1981 and June 1999.
The group analyzed scholecystectomy rate, hospital stay, and postoperative mortality. Regression methods were used to examine the effect of laparoscopic experience and surgeon caseload on postoperative mortality and hospital stay.
The study revealed that from 1989 to 1999 the proportion of cholecystectomies done laparoscopically rose from none to 80%. The age-standardised cholecystectomy rate increased by 20% (95% CI 15-26).
Lap-cholecystectomies rose from 0 to 80%, and post-op stay fell from 8.0 to 2.9 d.
Postoperative mortality did not change in the 1990s (odds ratio 0·99 [0·7-1·4], p=0·99). The mean postoperative hospital stay fell from 8·0 (SD 3·7) to 2·9 (3·2) days. There was wide variation between hospitals in the proportion of cholecystectomies done laparoscopically and in average hospital stay.
For individual surgeons, increasing laparoscopic experience and annual caseload were associated with higher proportions of laparoscopic procedures and shorter hospital stays.
Postoperative mortality was higher during the first ten laparoscopic cholecystectomies done by a surgeon (compared with >200 procedures, odds ratio 2·3 [1·2-4·6], p=0·015).
The team concluded that the laparoscopic method reduced hospital stay but had no overall effect on postoperative mortality.
Dr Colin Fischbacher on behalf of the group said, "Studies to assess the appropriateness of the increased cholecystectomy rate are merited. The wide variation in the proportion done laparoscopically, together with evidence of better results for surgeons doing more procedures, suggests scope for further reductions in hospital stay and morbidity."