The Influence of Surgeon Subspecialty in Laparoscopic Cholecystectomy: A Population-Based Study.

BACKGROUND

Laparoscopic cholecystectomy (LC) is performed by surgeons from various specialties and remains central to minimally invasive surgical training. This study assessed whether surgeon subspecialty affects patient outcomes and explored aspects of LC education.

METHODS

This population-based study included 46,700 LCs performed between 2020 and 2023, using data from the Swedish Registry for Gallstone Surgery (GallRiks). Surgeons were categorized as resident surgeons (RS), attending surgeons (AS), upper gastrointestinal/hepatopancreatobiliary surgeons (UGIS), acute care surgeons (ACS), or alternate subspecialty surgeons (ASS). Primary outcomes were 30-day adverse events (AE), bile duct injuries (BDI), and operative time (OT). Educational activity and subgroup analyses for elective and acute cholecystitis cases were evaluated.

RESULTS

AE rates were higher for ACS (9.6%; OR 1.22, 95% CI 1.07-1.40) and AS (7.9%; OR 1.17, 95% CI 1.06-1.19) compared to UGIS (6.9%) but without increased BDI rates. RS demonstrated similar AE rates (6.1%) but lower BDI rates in elective cases (0.08%). OT was 24-33 min shorter for UGIS than for other surgeon types. Educational activity prolonged OT by 12 min (OR 1.06; 95% CI 1.05-1.08).

DISCUSSION: Higher AE rates among ACS and AS likely reflect more complex cases. LC performed by RS appears equally safe and efficient, provided appropriate supervision is available.