J Callaghan1. 1. Department of Surgery, Winneshiek County Memorial Hospital, Decorah, Iowa.
Abstract
BACKGROUND: During a 25-year period from 1967 to 1991, 1,058 gallbladder operations were done by one surgeon in solo practice in a rural 50-bed hospital. METHODS: Open cholecystectomy was performed on all but 6 patients who had cholecystostomy. Operative cholangiography was liberally used, and 19% of all patients required common duct exploration. The majority of the patients were older than 65 years of age and 19% were older than 75 years of age. RESULTS: The overall mortality was 0.7%. There were no deaths following cholecystectomy for chronic or acute nongangrenous cholecystitis, and all deaths occurred in patients older than 77 years of age. Most of the deaths occurred prior to 1978 and the last death was recorded in 1984. CONCLUSIONS: Rural America has a comparatively large proportion of the elderly population of our nation. Most of these patients prefer to have their surgery performed locally, provided the results are comparable with those of large neighboring medical centers. The results from this current series from a small rural hospital compare favorably with the published results from large medical and academic centers.
BACKGROUND: During a 25-year period from 1967 to 1991, 1,058 gallbladder operations were done by one surgeon in solo practice in a rural 50-bed hospital. METHODS: Open cholecystectomy was performed on all but 6 patients who had cholecystostomy. Operative cholangiography was liberally used, and 19% of all patients required common duct exploration. The majority of the patients were older than 65 years of age and 19% were older than 75 years of age. RESULTS: The overall mortality was 0.7%. There were no deaths following cholecystectomy for chronic or acute nongangrenous cholecystitis, and all deaths occurred in patients older than 77 years of age. Most of the deaths occurred prior to 1978 and the last death was recorded in 1984. CONCLUSIONS: Rural America has a comparatively large proportion of the elderly population of our nation. Most of these patients prefer to have their surgery performed locally, provided the results are comparable with those of large neighboring medical centers. The results from this current series from a small rural hospital compare favorably with the published results from large medical and academic centers.