• J. Am. Coll. Surg. · Jul 2010

    Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient?

    • Melissa M Murphy, Sing-Chau Ng, Jessica P Simons, Nicholas G Csikesz, Shimul A Shah, and Jennifer F Tseng.
    • Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA 01655, USA.
    • J. Am. Coll. Surg. 2010 Jul 1;211(1):73-80.

    BackgroundRegionalization of care has been proposed for complex operations based on hospital/surgeon volume-mortality relationships. Controversy exists about whether more common procedures should be performed at high-volume centers. Using mortality alone to assess routine operations is hampered by relatively low perioperative mortality. We used a large national database to analyze the risk of major in-hospital complications after laparoscopic cholecystectomy (LC).Study DesignPatients undergoing LC were identified in the Nationwide Inpatient Sample 1998-2006 from states with surgeon/hospital identifiers. Previously validated major complications including acute myocardial infarction, pulmonary compromise, postoperative infection, deep vein thrombosis, pulmonary embolism, hemorrhage, and reoperation were assessed. Univariate and multivariable analyses were performed and independent risk factors of complications were identified.ResultsA total of 1,102,071 weighted patient discharges were identified, with a complication rate of 6.8%. Univariate analyses showed that advanced age, male gender, and higher Charlson Comorbidity Score were associated with higher complication rates (p < 0.0001). Higher surgeon volume (>or=36/year versus <12/year) and higher hospital volume (>or=225/year versus ConclusionsMajor in-hospital complications after LC are associated with individual patient characteristics rather than surgeon or hospital operative volumes. These results suggest regionalization of general surgical procedures might be unnecessary. Rather, careful patient selection and preoperative preparation can diminish overall complication rates.Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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