The vanishing elective cholecystectomy. Trends and their consequences.

During the 1980s, there have been ongoing changes in the policies and programs that govern the health care provision system. To assess the effect of these changes on patient care, the charts of patients undergoing cholecystectomy in 1980 (132 patients) and 1986 (108 patients) were reviewed and compared. The patients are increasingly over 60 years of age. The elective cholecystectomy is being replaced by procedures for more advanced disease as referrals of patients to the surgeon are delayed. The morbidity more than doubled. Compared with 1980, the policies and programs in effect during 1986 allowed fewer patients to undergo cholecystectomy (-18%), but required a markedly increased cost for those patients (+22%).