Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

CholeS Study Group, West Midlands Research Collaborative

    Research output: Contribution to journalArticlepeer-review

    13 Citations (Scopus)

    Abstract

    BACKGROUND: The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

    METHODS: Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

    RESULTS: Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m(2) , who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

    CONCLUSION: Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

    Original languageEnglish
    Pages (from-to)1716-1726
    Number of pages11
    JournalBritish Journal of Surgery
    Volume103
    Issue number12
    Early online date17 Oct 2016
    DOIs
    Publication statusPublished - 1 Nov 2016

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