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20 Year Trends in Laparoscopic Cholecystectomy for Biliary Dyskinesia, Patient Factors and Health Resource Utilization
Vamsi V. Alli*3, Jie Yang1,2, Jianjin Xu2, Aurora Pryor3, Mark A. Talamini3, Dana A. Telem3,4
1Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, NY; 2Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY; 3Department of Surgery, Stony Brook Medicine, Stony Brook, NY; 4Program in Public Health, Stony Brook Medicine, Stony Brook, NY
Background:
Benign biliary disease spans a spectrum of chronicity and severity. Despite high prevalence, there is disparity in patient characteristics amongst patients with gallbladder pathology. We hypothesized that the diagnosis and treatment of biliary dyskinesia (BD) is influenced by more than patient demographics alone, with payer class and other economic factors playing a significant role. Utilizing a cohort of patients from New York state spanning 20 years, we examined relationships between patient factors and the operative indication of BD.
Methods:
The New York State Planning and Research Cooperative System (NY SPARCS), a longitudinal administrative database encompassing all inpatient, outpatient and hospital discharges in NY State was utilized to identify patients undergoing laparoscopic cholecystectomy (LC) with BD as the operative indication. Demographic variables, payer source and economic data (median per capita income in county of residence) were examined. Baseline population characteristics were determined using 2010 US Census Bureau data, insured patient data was obtained from the Centers for Medicare and Medicaid Services and New York state data sources. Patient records corresponding to the study parameters were extracted from the NY SPARCS database, records with incomplete demographic data and younger than 18 years old were excluded. 10,662 patients from 1995-2014 underwent LC for BD in NY state and were included in this study. Descriptive statistical methods were used for aggregate data and Poisson regression model was used to examine linear trend over years. Categorical variables were compared using Chi square test and continuous variables using Welch’s t-test.
Results:
Our data demonstrates a steady rise in the rate of LC for BD, with a 7.57% increase per annum, p<0.0001. Compared to the New York State population at large, a disproportionate number of patients were women, Relative Risk (RR): 1.57, with the majority of patients presenting in the 4th & 5th decades of life, RR: 1.88. Socioeconomic factors including: non-governmental (non-Medicare, non-Medicaid) payer class and income bracket were positively correlated with BD as the operative indication for LC. A non-governmental payment source was associated with a RR of 1.22, while >60% of the operations for BD were performed on patients in the top 40% earning bracket in NY State.
Conclusion:
The frequency of operations for BD has been rising steadily for the past twenty years. Two socioeconomic factors, payment source and income bracket, are correlated with LC for BD. With an expanding utilization of LC for BD, and patients with the resources to seek surgical care, prudent use of resources must be maintained. Additionally, attention to those without commensurate resources is essential to avoid fostering health care disparity.
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