Home  |  About  |  Contact  |  Join MCACS  Donate to MCACS
Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
56th Annual Meeting Abstracts


Predictors of Major Complication Following Laparoscopic Cholecystectomy: Surgeon, Hospital or Patient?
Melissa M. Murphy, MD, MPH, Shimul A. Shah, MD, Jessica P. Simmons, MD, Nicholas G. Csikesz, BS, Sing-Chau Ng, MS, Jennifer F. Tsend, MD, MPH 
University of Massachusetts Medical School, Worcester, MA

PURPOSE OF STUDY

Regionalization of care has been proposed for complex operations based on hospital/surgeon volume-mortality relationships. Controversy exists whether common surgeries should be performed at high-volume centers. Using mortality to assess routine operations is hampered by low perioperative mortality. We used a large national database to analyze the risk of major in-hospital complications following laparoscopic cholecystectomy (LC).

 

 

METHODS USED

Patients undergoing LC were identified in the Nationwide Inpatient Sample 1998-2006 from states with surgeon/hospital identifiers. Previously validated major complications including acute MI, pulmonary compromise, postoperative infection, DVT, PE, hemorrhage, and reoperation were assessed. Univariate and multivariable analyses were performed; independent risk factors of complications were identified.

 

 

SUMMARY OF RESULTS

1,102,071 weighted patient-discharges were identified with a complication rate of 6.7%. Univariate analyses: Advanced age, male sex, higher Charlson score were associated with higher complications (p<.0001). Higher surgeon-volume (≥39/year vs. <12/year) and higher hospital-volume (≥225/year vs. <120/year) were associated with fewer complications (6.5% vs. 6.9%, 6.8% vs. 6.3%, respectively; p<.0001). Multivariable analysis: Advanced age (≥65 years vs. <65, adjusted odds ratio (AOR) 1.77; 95% confidence interval (CI) 1.61-1.94), male sex (AOR 1.15; 95% CI 1.11-1.19), and comorbidities (Charlson score 2 vs. 1, AOR 2.4; 95% CI 2.27-2.58) were associated with complications. Neither surgeon nor hospital volume was independently associated with increased risk of complications.

 

 

CONCLUSIONS

Major in-hospital complications following LC are associated with individual patient characteristics, rather than surgeon or hospital operative volumes. These results suggest regionalization of general surgical procedures may be unnecessary. Rather, careful patient selection and preoperative preparation may diminish overall complication rates.  

 

 


 

 Home | About | Contact