72.04 A Nationwide View on Recent Trends in Partial Cholecystectomy

Posted on January 31, 2019

A. F. Sabour2, K. Matsushima1, E. Alicuben1, M. Schellenberg1, K. Inaba1, D. Demetriades1  1LAC+USC Medical Center,Acute Trauma Surgery,Los Angeles, CALIFORNIA, USA 2Keck School of Medicine of USC,Medicine,Los Angeles, CALIFORNIA, USA

Introduction:
Partial cholecystectomy provides a viable alternative to the proverbial “difficult” gallbladder. To date, few studies have observed the establishment of partial cholecystectomy as an increasingly common surgical practice. The purpose of this study was to assess nationwide trends of partial cholecystectomy through evaluation of operative variables, patient- and institution-level characteristics, and yearly rates in procedure preference.

Methods:
Data was obtained from the Nationwide Inpatient Sample (NIS) between 2003 to 2014. Patients with an ICD-9-CM diagnostic code for acute cholecystitis were categorized based on procedures for either open total, laparoscopic total, open partial, or laparoscopic partial cholecystectomy. Any patients younger than 18 years of age or with a preoperative stay longer than 1 week were excluded. Logistic regression analysis was performed to evaluate significant patient- and institution-level characteristics associated with the use of partial cholecystectomy.

Results:
A total of 298,009 patients were evaluated over 12 years. During our study period, the rate of partial cholecystectomy sharply increased from 0.22% of all cholecystectomy procedures to 0.80% (p<0.001). Conversion from a general laparoscopic to open partial cholecystectomy increased significantly from 0% in 2003 to 4.76% in 2014 (p=0.049). Partial cholecystectomies were performed at significantly higher rates in males (OR: 1.96, p<0.001), Asian Americans (OR: 2.15, p=0.037), and patients with alcohol abuse (OR: 2.23, p=0.024). Teaching hospitals (OR: 2.28, p<0.001) and those in rural areas (OR: 2.27, p=0.001) were also found with significantly higher numbers of partial cholecystectomies.

Conclusion:
Growing trends in the use of partial cholecystectomy suggest evolving surgical practices for acute cholecystitis. Current data suggests that gender, ethnicity, and hospital characteristics may already play a deciding role in procedure preference. Future studies are warranted to determine the indications for partial cholecystectomy and its outcome benefit.