Brett D Mador1, Avery B Nathens2, Wei Xiong3, O Neely M Panton4, S Morad Hameed4. 1. Department of Surgery, St. Michael's Hospital, 80 Bond St, Donnelly Wing 3-070, Toronto, ON, M5B 1W8, Canada. brett.mador@outlook.com. 2. Department of Surgery, University of Toronto, Toronto, Canada. 3. Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada. 4. Department of Surgery, University of British Columbia, Vancouver, Canada.
Abstract
BACKGROUND: Choledocholithiasis is commonly treated initially with endoscopic sphincterotomy, followed by cholecystectomy to definitively address the underlying problem of cholelithiasis. While the benefits of early cholecystectomy have been realized in other populations, the preferred timing for this subset of patients is less well established. We performed a large, population-based analysis to determine the frequency, benefits, and practice variance in regard to early cholecystectomy on a provincial level. METHODS: Patients undergoing endoscopic sphincterotomy followed by cholecystectomy in British Columbia, Canada, from January 2001 to December 2011 were identified using fee-code billing data. Multiple databases were linked to obtain information on demographics, admissions, procedures, mortality, and census geographic data. Regression analysis was performed for length of stay (LOS) and additional procedures. Outcome data were risk adjusted for age, gender, comorbidities, socioeconomic status, and year of procedure. Variability of early cholecystectomy crude rates across census areas was determined using a funnel plot. RESULTS: There were 4287 eligible patients. Of these, 1905 (44.4%) underwent early cholecystectomy, defined as surgery within 14 days of sphincterotomy. Median interval to cholecystectomy was 2 days for the early cholecystectomy group and 61 days for delayed. There was a significant difference in hospital LOS favoring early cholecystectomy for patients with documented gallstone disease (p < 0.05). Patients initially admitted to a surgical service were more likely to undergo early cholecystectomy (60 vs. 36%, p < 0.001). There was no difference between groups in terms of bile duct injury or mortality. There was wide variability in rates of early cholecystectomy among census areas (range 0-96%) and health regions (range 20-66%) which was not explained by population density or geography. CONCLUSION: Early cholecystectomy is the ideal approach to gallstone disease post-sphincterotomy. Despite this, a large amount of clinical variance exists in regard to timing of cholecystectomy which seems to be primarily institution dependent.
BACKGROUND:Choledocholithiasis is commonly treated initially with endoscopic sphincterotomy, followed by cholecystectomy to definitively address the underlying problem of cholelithiasis. While the benefits of early cholecystectomy have been realized in other populations, the preferred timing for this subset of patients is less well established. We performed a large, population-based analysis to determine the frequency, benefits, and practice variance in regard to early cholecystectomy on a provincial level. METHODS:Patients undergoing endoscopic sphincterotomy followed by cholecystectomy in British Columbia, Canada, from January 2001 to December 2011 were identified using fee-code billing data. Multiple databases were linked to obtain information on demographics, admissions, procedures, mortality, and census geographic data. Regression analysis was performed for length of stay (LOS) and additional procedures. Outcome data were risk adjusted for age, gender, comorbidities, socioeconomic status, and year of procedure. Variability of early cholecystectomy crude rates across census areas was determined using a funnel plot. RESULTS: There were 4287 eligible patients. Of these, 1905 (44.4%) underwent early cholecystectomy, defined as surgery within 14 days of sphincterotomy. Median interval to cholecystectomy was 2 days for the early cholecystectomy group and 61 days for delayed. There was a significant difference in hospital LOS favoring early cholecystectomy for patients with documented gallstone disease (p < 0.05). Patients initially admitted to a surgical service were more likely to undergo early cholecystectomy (60 vs. 36%, p < 0.001). There was no difference between groups in terms of bile duct injury or mortality. There was wide variability in rates of early cholecystectomy among census areas (range 0-96%) and health regions (range 20-66%) which was not explained by population density or geography. CONCLUSION: Early cholecystectomy is the ideal approach to gallstone disease post-sphincterotomy. Despite this, a large amount of clinical variance exists in regard to timing of cholecystectomy which seems to be primarily institution dependent.
Authors: David W da Costa; Stefan A Bouwense; Nicolien J Schepers; Marc G Besselink; Hjalmar C van Santvoort; Sandra van Brunschot; Olaf J Bakker; Thomas L Bollen; Cornelis H Dejong; Harry van Goor; Marja A Boermeester; Marco J Bruno; Casper H van Eijck; Robin Timmer; Bas L Weusten; Esther C Consten; Menno A Brink; B W Marcel Spanier; Ernst Jan Spillenaar Bilgen; Vincent B Nieuwenhuijs; H Sijbrand Hofker; Camiel Rosman; Annet M Voorburg; Koop Bosscha; Peter van Duijvendijk; Jos J Gerritsen; Joos Heisterkamp; Ignace H de Hingh; Ben J Witteman; Philip M Kruyt; Joris J Scheepers; I Quintus Molenaar; Alexander F Schaapherder; Eric R Manusama; Laurens A van der Waaij; Jacco van Unen; Marcel G Dijkgraaf; Bert van Ramshorst; Hein G Gooszen; Djamila Boerma Journal: Lancet Date: 2015-09-26 Impact factor: 79.321
Authors: Jan Siert K Reinders; Annemarie Goud; Robin Timmer; Philip M Kruyt; Philip M Kruijt; Ben J M Witteman; Niels Smakman; Ronald Breumelhof; Sandra C Donkervoort; Jeroen M Jansen; Joos Heisterkamp; Marina Grubben; Marina Grobben; Bert van Ramshorst; Djamila Boerma Journal: Gastroenterology Date: 2010-03-02 Impact factor: 22.682
Authors: Djemila Boerma; Erik A J Rauws; Yolande C A Keulemans; Ignace M C Janssen; Clemens J M Bolwerk; Ron Timmer; Egge J Boerma; Huug Obertop; Kees Huibregtse; Dirk J Gouma Journal: Lancet Date: 2002-09-07 Impact factor: 79.321
Authors: S Vaccari; M Minghetti; A Lauro; M I Bellini; A Ussia; S Khouzam; I R Marino; M Cervellera; V D'Andrea; V Tonini Journal: Dig Dis Sci Date: 2022-03-22 Impact factor: 3.199