C. S. Latenstein1, S. Z. Wennmacker1, F. Atsma2, M. Noordenbos2, S. Groenewoud2, P. R. De Reuver1 1Radboudumc,Surgery,Nijmegen, NIJMEGEN, Netherlands 2Radboudumc,Scientific Institute For Quality Of Healthcare,Nijmegen, NIJMEGEN, Netherlands
Introduction:
Approximately, 700,000 cholecystectomies are performed in the US every year. Based on Medicare data the Darthmouth Atlas of Healthcare shows that the chance a patient will have surgical treatment for gallstones can vary across hospitals, with a factor score ranging from 2 to 4 fold difference. Nationwide longitudinal data about cholecystectomy rates in all patients presenting at the surgical outpatient clinic are lacking. We aimed to determine the longitudinal practice variation for cholecystectomy in the Netherlands.
Methods:
A population based analysis was performed for gallstones patients in all Dutch general hospitals from 2013 up to 2015. Operation rates were determined for each hospital by dividing the absolute number of operated patients by the total patients who consulted a surgeon for gallstones. Differences in operation rates between academic, teaching and non-teaching hospitals were evaluated. Operation rates were adjusted for differences in age, sex and Social Economic Status (SES) to summarize a factor score for practice variation. This score was calculated by dividing the adjusted operation rate of the 95% percentile by the adjusted operation rate of the 5% percentile to asses a trend in practice variation over time.
Results:
A total of 89,316 patients (33.1% male, mean age 54.1 years) with gallstones were included from all hospitals during the study period. The average nationwide operation rate for cholecystectomy was 76.1%. The difference in operation rate ranged between centers ranged from 44.7% to 97.7%. The average operation rate in eight academic hospitals was 60.7%, 75.7% in 44 teaching hospital and 79.6% in 31 non teaching hospitals. The summarized annual factor score for 75 general (teaching and non-teaching) hospitals was 1.3 in all three years.
Conclusion:
Unadjusted operation rates for cholecystectomy vary among hospitals, but the factor score illustrates a relatively low practice variation and comparable adjusted operation rates in the Netherlands. Compliance to evidence based guidelines and uniformity in decision making could potentially contribute to a low practice variation in gallbladder removal compared to other countries.