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Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics

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Abstract

Background

The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome.

Methods

The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay.

Results

A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3 %) cases and increased by 14.6 % over the study period. The in-patient mortality rate (0.2 %), 1 year mortality rate (1 %), proportion of cases converted to open (5.0 %), major BDI rate (0.4 %), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5 %) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.35–1.44) and specialist units (OR 1.32, 95 % CI 1.30–1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95 % CI 1.05–1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes.

Conclusions

The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.

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Acknowledgments

Peter Holt is a clinician scientist who is financially supported by the National Institute for Health Research (NIHR-CS-011-008). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Disclosures

Drs. Sinha, Poloniecki, Stoker, Friend, Holt, Thompson and Mr Hofman have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Outcomes Research, St. George’s Vascular Institute, London, SW17 0QT, UK

    Sidhartha Sinha, David Hofman, Jan D. Poloniecki, Matt M. Thompson & Peter J. E. Holt

  2. Department of General Surgery, North Middlesex University Hospital NHS Trust, London, UK

    David L. Stoker

  3. Nuffield Department of Surgery, Churchill Hospital, Oxford, UK

    Peter J. Friend

  4. Population Health Sciences and Education, St. George’s University of London, London, UK

    Jan D. Poloniecki

Authors
  1. Sidhartha Sinha
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  2. David Hofman
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  3. David L. Stoker
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  4. Peter J. Friend
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  5. Jan D. Poloniecki
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  6. Matt M. Thompson
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  7. Peter J. E. Holt
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Correspondence to Sidhartha Sinha.

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Sinha, S., Hofman, D., Stoker, D.L. et al. Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics. Surg Endosc 27, 162–175 (2013). https://doi.org/10.1007/s00464-012-2415-0

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  • DOI: https://doi.org/10.1007/s00464-012-2415-0

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