Influence of Surgeon Volume on Clinical and Economic Outcomes of Laparoscopic Cholecystectomy

Abstract

Background and Purpose: The volume-outcome effect has been well documented in both medical treatment and surgery. The relationship of volume-outcome utilization in laparoscopic cholecystectomy has not been studied. The aims of this study were to examine whether the operational volume of individual surgeons is associated with the clinical and economic outcomes of patients with gallbladder diseases undergoing laparoscopic cholecystectomy. Methods: A retrospective study was made of all patients who underwent elective laparoscopic cholecystectomy in the Department of Surgery, Kaohsiung Medical University Hospital between January 1998 and April 2002. In total, 916 patients were operated on by 4 surgeons and the volume for each surgeon was 502, 192, 147, and 75 cases, respectively. Clinical and economic information for each patient was abstracted from medical charts and the financial division. Multiple logistic and linear regression models were used to examine the relationship between three outcome variables, complications, length of stay, total hospital charges, and surgeon volume while controlling for the severity of illness and other selected covariates (morbidity index). Results: Overall, a complication rate of 1.2% was identified. On average, the patient’s stay in hospital was 4.7 days, and the average total hospital charge was TWD 49,581. After adjusting for covariates, three regression models indicated that the surgeon with the highest volume had the lowest complication rate, shortest length of stay, and lowest hospital charges. Conclusions: The operative volume of individual surgeons not only had a positive impact on clinical outcomes, it also had greater effect on conservation of health care resources. The findings validate the theory of practice makes perfect.

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

“…Seventy‐five (20.4%) of 367 patients encountered postoperative complications in the CLC group. Nine (2.45%) patients suffered from biliary tract‐related complications, Grade IIIa, and one (0.45%) from incisional hernia, Grade IIIb, although most of them, 64 out of 75 patients (85%), experienced minor complications; Clavien‐Dindo classification Grade I, 50 patients; Grade II, 14 patients in this study with major complications including retained common bile duct (CBD) stone, bile duct stricture(injury), bile juice leakage, and subhepatic fluid collection as similar to previous reports with a range of 1.2∼3.6% [14–20]. For two decades, major complications of LC still cannot be avoided.…”

Health‐related quality of life in patients undergoing cholecystectomy

“…Differences in national health conditions may explain the discrepancy. An earlier Taiwan study of cholecystectomy patients reported that percutaneous transhepatic gallbladder drainage may be a major cause of increased ALOS [20]. A longer preoperation hospital day may also increase ALOS.…”

Patient comorbidities increase postoperative resource utilization after laparoscopic and open cholecystectomy

“…Injury to the common bile duct is well known as a major contributor to cost and resource utilization, with immediate associated costs ranging from $13,612 to $30,000 and lifetime costs reported as high as $300,000 [21][22][23][24] . In addition, various patient, hospital, and surgeon factors -such as age, sex, presence of comorbidities, urgency of admission and surgery, length of stay (LOS), treatment in a regional or district hospital, hospital volume, and surgeon experience [25][26][27][28][29][30][31][32] -have been shown to affect cholecystectomy outcomes and associated overall resource use and costs.…”