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 24 February 2018

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News

Patient demographics predict cholecystectomy outcomes

Patient and hospital demographics affect the outcomes with inpatient cholecystectomy, while increased age, and emergency surgery predict mortality, finds the most recent issue of Surgical Endoscopy.

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Dr Heniford and colleagues examined the influence of patient and hospital demographics on cholecystectomy outcomes.

Data was obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database in 2000.

The researchers obtained data for all patients undergoing inpatient cholecystectomy at 994 nationwide hospitals.

The research team determined differences using standard statistical methods.

Of 93,578 cholecystectomies, the team noted that 73% were performed laparoscopically.

Length of hospital stay, charges, morbidity, and mortality were significantly less for laparoscopic cholecystectomy.

The team found that increasing patient age was associated with increased length of hospital stay, charges, morbidity, and mortality.

Increasing patient age was associated with a decreased laparoscopic cholecystectomy rate.

Charges, length of hospital stay, morbidity, and mortality were highest for males with a lower laparoscopic cholecystectomy rate than for females.

The researchers observed that mortality and length of hospital stay were higher, whereas morbidity was lower for African Americans than for whites.

Hispanics had the shortest length of hospital stay, as well as the lowest morbidity and mortality rates.

The team found that laparoscopic cholecystectomy was performed more commonly for Hispanics than for whites or African Americans.

Medicare-insured patients incurred longer length of hospital stay as well as higher charges, morbidity, and mortality than Medicaid, private, and self-pay patients.

The research team noted that medicare-insured patients were the least likely to undergo laparoscopic cholecystectomy.

The team observed as median income decreases, length of hospital stay increases, and morbidity decreases with no mortality effect.

As hospital size increased, length of hospital stay, and charges increased
Surgical Endoscopy

Teaching hospitals had a longer length of hospital stay, higher charges, and mortality than non-teaching centers.

The researchers also found that teaching hospitals had a lower laparoscopic cholecystectomy rate, with no difference in morbidity, than nonteaching centers.

As hospital size increased, length of hospital stay, and charges increased, with no difference in morbidity.

Large hospitals had the highest mortality rates and the lowest incidence of laparoscopic cholecystectomy.

In addition, urban hospitals had higher charges and laparoscopic cholecystectomy, with a lower laparoscopic cholecystectomy rate than rural hospitals.

After control was used for all other covariates, the researchers found that increased age was a predictor of increased morbidity.

Female gender, laparoscopic cholecystectomy, and intraoperative cholangiogram all predicted decreased morbidity.

The team also noted that increased age, complications, and emergency surgery predicted increased mortality.

The research team observed that laparoscopy and intraoperative cholangiogram had protective effects.

However, patient income, insurance status, and race did not play a role in morbidity or mortality.

The researchers also found that academic or teaching status of the hospital also did not influence patient outcomes.

Dr Heniford's team concluded, “Patient and hospital demographics do affect the outcomes of patients undergoing inpatient cholecystectomy.”

“Although male gender, African American race, Medicare-insured status, and large, urban hospitals are associated with less favorable cholecystectomy outcomes, only increased age predicts increased morbidity.”

“Female gender, laparoscopy, and cholangiogram are protective.”

“Increased age, complications, and emergency surgery predict mortality, with laparoscopy and intraoperative cholangiogram having protective effects.”

Surg Endosc 2005: 19(6): 767-73
01 September 2005

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