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DISPARITIES IN LAPAROSCOPIC CHOLECYSTECTOMY SETTINGS IN THE UNITED STATES: 2013 AMBULATORY DATABASE ANALYSIS
Piotr J. Bachul, Ghaith Al-Qudah^*, Kenneth W. Bueltmann, Marek Rudnicki
Surgery, University of Illinois, Advocate Masonic Medical Center, Chicago, IL
INTRODUCTION: With the development of minimally invasive techniques and parallel attempts at cost reduction, ambulatory/outpatient laparoscopic cholecystectomy (OLC) has become an acceptable option for many patients. Although some patients require inpatient surgery (ILC), the predominant group of patients can be treated in the outpatient setting. The choice of setting for these treatments has the potential to be disproportionally biased by different factors.
MATERIAL AND METHODS: The Ambulatory Healthcare Utilization Project database was queried for LC performed in 2013. ICD-9 procedural code 51.23 was used for all queries. OLC and ILC were compared for frequency, patient demographics, socioeconomic status, patient residence and payer type. Chi-Square tests were used for statistical analysis of differences.
RESULTS: A total number of 444,611 LCs were identified in the 2013 database. 183,452 (41.3%) were done in the ambulatory setting vs. 261,159 (58.7%) as an inpatient treatment. Proportionally, more male patients underwent OLC (65.5% vs. 34.5% inpatient) than females (55.7% vs. 44.3%, respectively). Privately insured patients had a narrow distribution between operative settings (51.3% vs 48.7%); patients covered by other carriers favored ILC in comparison to OLC (Medicare, 66.7% vs. 33.3%, Medicaid 63.6% vs. 36.4%, and uninsured 75.3% vs. 24.7%). Patient income level did not affect the choice of setting (40.3-44.3% vs 59.7-55.7% for high and low income patients).The majority of patients in large metropolitan areas and the suburbs underwent ILC (77.8% inpatient vs 22.2% outpatient), whereas in rural areas, procedures were more often performed as an OLC (46.1% inpatient vs 53.9% ambulatory). White ethnicity did not influence location of treatment (51.6% inpatient vs 48.4% ambulatory), whereas Blacks, Hispanics, Asian/Pacific Islanders, Native Americans more commonly received ILC (63.4%, 82.7%, 77.5% and 71.8%, respectively). All comparisons demonstrate p<.0001.
CONCLUSIONS: There are disparities in the United States concerning the setting of LC surgeries. This procedure is more likely to be performed as ILC in metropolitan areas and suburbs whereas patients in rural locations are treated more often as an OLC. The Majority of Medicare, Medicaid and uninsured patients were treated as ILC. The same holds true for Blacks, Hispanics, Asian/pacific Islanders and Native Americans. Collected data reflects only a limited sample of LC performed in the US.

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