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J Pediatr Surg. 2012 Apr;47(4):673-80. doi: 10.1016/j.jpedsurg.2011.10.054.

Surgeon volume trumps specialty: outcomes from 3596 pediatric cholecystectomies.

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  • 1Department of Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520, USA.

Abstract

BACKGROUND:

Laparoscopic cholecystectomy is the standard surgical management of biliary disease in children, but there has been a paucity of studies addressing outcomes after pediatric cholecystectomies, particularly on a national level. We conducted the first study to address the effect of surgeon specialty and volume on clinical and economic outcomes after pediatric cholecystectomies on a population level.

METHODS:

We 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. χ(2), 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.

CONCLUSIONS:

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.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
22498380
[PubMed - indexed for MEDLINE]
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