Surgeon volume trumps specialty: outcomes from 3596 pediatric cholecystectomies

Journal of Pediatric Surgery, 04/13/2012

High–volume surgeons have better outcomes after pediatric cholecystectomy than low–volume surgeons. To optimize outcomes in children after cholecystectomy, surgeon volume and laparoscopic experience should be considered above surgeon specialty.

Methods

  • Authors conducted a retrospective cross–sectional study using the Health Care Utilization Project Nationwide Inpatient Sample.
  • Children (≤17 years) who underwent laparoscopic cholecystectomy from 2003 to 2007 were selected.
  • Pediatric surgeons performed 90% or higher of their total cases in children.
  • High–volume surgeons were in the top tertile (n ≥ 37 per year) of total cholecystectomies performed. χ2, Analyses of variance, and multivariate linear and logistic regression analyses were used to assess in–hospital complications, median length of hospital stay (LOS), and total hospital costs (2007 dollars).

Results

  • A total of 3596 pediatric cholecystectomies were included.
  • Low–volume surgeons had more complications, longer LOS, and higher costs than high–volume surgeons.
  • After adjustment in multivariate regression, surgeon volume, but not specialty, was an independent predictor of LOS and cost.

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