Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes

Annals of Surgery
A Y ChenS Khuri

Abstract

To study the introduction of laparoscopic cholecystectomy to the 43 tertiary-care university-affiliated Veterans Administration medical centers (VAMCs) participating in the National Veterans Affairs Surgical Risk Study from October 1991 through December 1993. Previous studies in the private sector have documented growth in the number of cholecystectomies and falling clinical thresholds for cholecystectomy with the introduction of laparoscopic cholecystectomy. The following were analyzed for changes over time: measures of patient preoperative risk, complexity of surgery, severity of biliary disease, numbers of procedures, postoperative length of stay, and 30-day postoperative mortality and general complication rates. The number of cholecystectomies performed laparoscopically increased, but the total number of cholecystectomies performed remained stable over time. The proportion of patients with acute cholecystitis, emergent cholecystectomies, and technically complex cholecystectomies did not change or increased slightly over time. Adjusted odds for postoperative general complications were lower for laparoscopic than for open cholecystectomy, but 30-day postoperative mortality and general complication rates for all cholecystectom...Continue Reading

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Citations

Sep 12, 2000·Current Gastroenterology Reports·S A Ahrendt
Nov 23, 2000·Lancet·A J McMahonM C MacLeod
Jun 8, 1999·Journal of the American College of Surgeons·A M ArozullahC L Bennett
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Aug 13, 2013·Digestive Diseases and Sciences·Nitin Aggarwal, Klaus Bielefeldt
Oct 8, 2020·Surgical Endoscopy·Joshua KongGamal Mostafa
Jan 6, 2021·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·James A RandallFred Brody
Mar 27, 2007·Surgery·Jennifer F TsengDouglas B Evans

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