The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland · 2025
Do hospital and surgeon volumes impact the outcomes of patients undergoing cholecystectomy in Ireland? A national registry based study.
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Linehan E, Kehoe J D, Gall T, McEntee G, Conneely J, O'Connell R M
Аннотация
INTRODUCTION: Biliary pathology can have an enormous burden on both the patient and the health service with acute cholecystitis being diagnosed in 10 % of patients that present with acute abdominal pain. Emergency or elective laparoscopic cholecystectomy is the recommended treatment option for these patients. It has been shown previously that surgical and hospital volume affect outcomes from emergency abdominal surgery in Ireland, but no such investigation has been done specifically for cholecystectomies.
AIM: To determine if there is a link between the hospital and surgeon volume of cholecystectomies performed and their associated outcomes in Irish hospitals.
METHODS: This was a retrospective registry study using National Quality Assurance & Improvement System (NQAIS). All patients who underwent cholecystectomy in Irish public hospitals from January 2017 until December 2023 were identified. Hospitals and surgeons were divided into groups of high, medium and low volume based on the number of cholecystectomies performed per year during the study period. Data including the demographics, admission details and outcomes of patients who underwent cholecystectomy were extracted from the database for analysis.
RESULTS: A total of 28,835 patients in 35 hospitals were included. Adverse outcomes were reported in 1952 patients who underwent a cholecystectomy. An association was found between adverse outcomes including bile duct injury (0.10 % vs 0.03 %, p < 0.001) and critical care admission (2.7 % vs 1.97 %, p < 0.022) and patients who had surgery in low volume hospitals compared to high volume centres. No statistically significant difference in adverse outcome was reported for the low surgical volume patients. Risk factors associated with adverse outcome following cholecystectomy were age >65, high pre-operative morbidity, emergency surgery and low hospital volume (p < 0.001).
DISCUSSION: Patients undergoing cholecystectomy in low volume hospitals have a higher risk of adverse events. Surgeons who perform low volumes of cholecystectomies appear to perform a higher percentage of emergency cholecystectomies without a statistically significant difference in their outcomes.
AIM: To determine if there is a link between the hospital and surgeon volume of cholecystectomies performed and their associated outcomes in Irish hospitals.
METHODS: This was a retrospective registry study using National Quality Assurance & Improvement System (NQAIS). All patients who underwent cholecystectomy in Irish public hospitals from January 2017 until December 2023 were identified. Hospitals and surgeons were divided into groups of high, medium and low volume based on the number of cholecystectomies performed per year during the study period. Data including the demographics, admission details and outcomes of patients who underwent cholecystectomy were extracted from the database for analysis.
RESULTS: A total of 28,835 patients in 35 hospitals were included. Adverse outcomes were reported in 1952 patients who underwent a cholecystectomy. An association was found between adverse outcomes including bile duct injury (0.10 % vs 0.03 %, p < 0.001) and critical care admission (2.7 % vs 1.97 %, p < 0.022) and patients who had surgery in low volume hospitals compared to high volume centres. No statistically significant difference in adverse outcome was reported for the low surgical volume patients. Risk factors associated with adverse outcome following cholecystectomy were age >65, high pre-operative morbidity, emergency surgery and low hospital volume (p < 0.001).
DISCUSSION: Patients undergoing cholecystectomy in low volume hospitals have a higher risk of adverse events. Surgeons who perform low volumes of cholecystectomies appear to perform a higher percentage of emergency cholecystectomies without a statistically significant difference in their outcomes.