The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997-2006
James P. Dolan*, Brian S. Diggs, Brett C. Sheppard, John G. Hunter
Surgery, L-223A, Oregon Health and Science University, Portland, OR
PURPOSE: To determine the mortality rate, and significant associated factors, related to laparoscopic (LC) and open cholecystectomies (OC) over a 10-year period in the United States.METHODS: Using the Nationwide Inpatient Sample (NIS) of approximately seven million inpatient records per year, we extracted and analyzed data for both LC and OC between 1997 and 2006. Cholecystectomies performed as part of another primary procedure were excluded. Using procedure-specific codes, we calculated annual national volumes for both open and laparoscopic cholecystectomies for the time period under review and the associated in-hospital mortality rate following both of these procedures. Using logistic regression modeling, we then analyzed selected patient (age, gender, admission type, diagnosis) and institutional (hospital location and teaching status) characteristics to determine if a significant association existed between these factors and in-hospital mortality.RESULTS: There was an 8.9% increase in the volume of LC and a corresponding decrease in open procedures over the 10 years under review. In 2006, 19% of cholecystectomies were still performed using an open approach and the associated mortality remained significantly higher than that seen with LC (Table 1). Overall, after adjusting for patient and hospital characteristics, the mortality for OC was higher than that for LC (Odds Ratio 4.99 (95% CI 4.77-5.22), p<0.001). Age (> 61 years), male gender, non-elective admission, a primary diagnosis other than cholelithiasis and hospital location were all independently associated with increased mortality. The average mortality rate associated with conversion from LC to OC was found to be 0.7%.CONCLUSIONS: These data indicate an increase in the proportion LCs performed over the years under study with a decrease in the proportion of OCs. However, OCs remains associated with a significant mortality burden when compared with the laparoscopic approach.
Table 1. National volumes for cholecystectomy and associated mortality from 1997 to 2006.
| Number of Procedures (N (%)) | Mortality (N (%)) | |||||
| Year | All | Open | Laparoscopic | All | Open | Laparoscopic |
| 1997 | 413,634 | 115,779 (28.0) | 297,855 (72.0) | 6001 (1.5) | 4,673 (4.0) | 1,328 (0.4) |
| 1998 | 406,795 | 87,305 (21.5) | 319,490 (78.6) | 6,318 (1.6) | 4,457 (5.1) | 1,861 (0.6) |
| 1999 | 405,344 | 73,947 (18.2) | 331,397 (81.8) | 5,680 (1.4) | 3,862 (5.2) | 1,818 (0.5) |
| 2000 | 431,591 | 72,259 (16.7) | 359,332 (83.3) | 5,480 (1.3) | 3,646 (5.0) | 1,834 (0.5) |
| 2001 | 435,538 | 73,426 (16.9) | 362,111 (83.1) | 5,796 (1.3) | 3,697 (5.0) | 2,100 (0.6) |
| 2002 | 445,571 | 73,283 (16.4) | 372,288 (83.6) | 5,650 (1.3) | 3,763 (5.1) | 1,887 (0.5) |
| 2003 | 434,165 | 74,203 (17.1) | 359,962 (82.9) | 5,165 (1.2) | 3,193 (4.3) | 1,972 (0.5) |
| 2004 | 425,734 | 94,804 (22.3) | 330,930 (77.7) | 4,798 (1.1) | 3,299 (3.5) | 1,498 (0.5) |
| 2005 | 417,488 | 82,967 (19.9) | 334,521 (80.1) | 4,796 (1.1) | 2,910 (3.5) | 1,886 (0.6) |
| 2006 | 416,470 | 79,666 (19.1) | 336,804 (80.9) | 4,537 (1.1) | 2,958 (3.7) | 1,579 (0.5) |
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