GEOGRAPHICAL VARIATIONS IN USE AND COSTS OF CHOLECYSTECTOMY ACROSS THE UNITED STATES
Paul T. Kroner*, Alex M. Kesler, Peter Abader, Mohammad Afsh, Brian E. Lacy
Mayo Clinic Florida, Jacksonville, FL
Introduction
Cholecystectomy (CCY) is one of the most commonly performed abdominal surgeries. Different studies have shown significant variation in hospital stay, costs, and charges for various surgical procedures in the US. Data describing geographical variations in CCY performance is limited. The aim of this study was to examine geographical variations in CCY in the US in regards to number of cases, hospital costs, charges, and length of stay (LOS).
Methods
Case-control study using the NIS 2014, the largest public inpatient database in the US. All patients with ICD9CM procedural codes for same-admission CCY were included. None were excluded. The primary outcome was determining the temporal trends in the use of CCY distributed in the different US Census divisions. Secondary outcomes were determining the ethnic geographical distribution of patients undergoing CCY, as well as the inflation-adjusted hospital costs, charges and length of hospital stay (LOS) in patients undergoing CCY in the different geographical locations. Proportions and means were compared using Fisher's exact test and Student's t-test, respectively.
Results
A total of 369,975 patients underwent cholecystectomy in 2014 and were included in the study. The mean age was 53 years, and 61% were female. For the primary outcome, the highest percentage of cholecystectomies were performed in the South Atlantic (20.4%), and the Pacific (16.8%) divisions, wit were done in New England. Ethnicity also varied significantly across the nation, as Caucasians accounted for 64% of cases, followed by Hispanics (19%) and African Americans (10%). Mean hospital cost was highest in Pacific and East South Central, while mean charges were highest in Pacific, and lowest in New England. The national mean length of stay was 5 days. Stratification by region along with p-values for number of cases, ethnicity, hospital costs, charges, and LOS are depicted in Table 1.
Conclusion
In 2014, more cholecystectomies were performed in the South Atlantic than any other region. When stratifying by ethnicity, Caucasians clearly undergo the majority of cholecystectomies. This is thought to be secondary to the US ethnic composition. Hospital costs, and charges were significantly higher in the Pacific division and lowest in New England.
Total number of cholecystectomies, costs, charges and length of stay stratified by geographical US division and ethnicities for the year 2014.
| Variables | Total Cases | Proportion of national cases | Caucasian | African American | Hispanic | Mean Cost | Mean Charge | Mean Length of Stay (days) | p-value |
| Cholecystectomies New England Middle Atlantic East North Central West North Central South Atlantic East South Central West South Central Mountain Pacific | 369,975 13,410 47,990 49,350 22,915 75,590 23,215 49,445 25,895 62,165 | 100% 3.6% 13.0% 13.3% 6.2% 20.4% 6.3% 13.4% 7% 16.8% | 63.8% 77.2% 65.0% 75.2% 85% 64.3% 87.5% 54.4% 62.8% 44.9% | 10.2% 6.1% 10.9% 11.5% 8.2% 17.3% 8.3% 10.9% 3.1% 4.5% | 19.1% 12.5% 14.3% 8.4% 3.4% 14.1% 2.9% 28.2% 24.5% 38.5% | $16,627 $17,913 $15,216 $17,098 $16,883 $16,024 $14,363 $15,690 $15,702 $20,016 | $66,116 $43,889 $67,690 $57,435 $52,419 $66,506 $53,802 $68,982 $64,754 $85,662 | 5.03 4.82 5.20 5.22 4.95 5.33 5.32 5.15 4.45 4.47 | <0.01 |
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