National Trends in the Adoption of Laparoscopic Cholecystectomy over 7 Years in the United States and Impact of Laparoscopic Approaches Stratified by Age
Introduction. The aim of this study was to characterize national trends in adoption of laparoscopic cholecystectomy and determine differences in outcome based on type of surgery and patient age. Methods. Retrospective cross-sectional study of patients undergoing cholecystectomy. Trends in open versus laparoscopic cholecystectomy by age group and year were analyzed. Differences in outcomes including in-hospital mortality, complications, discharge disposition, length of stay (LOS), and cost are examined. Results. Between 1999 and 2006, 358,091 patients underwent cholecystectomy. In 1999, patients aged ≥80 years had the lowest rates of laparoscopic cholecystectomy, followed by those aged 65–79, 64–50, and 49–18 years (59.7%, 65.3%, 73.2%, and 83.5%, resp., ). Laparoscopic cholecystectomy was associated with improved clinical and economic outcomes across all age groups. Over the study period, there was a gradual increase in laparoscopic cholecystectomy performed among all age groups during each year, though elderly patients continued to lag significantly behind their younger counterparts in rates of laparoscopic cholecystectomy. Conclusion. This is the largest study to report trends in adoption of laparoscopic cholecystectomy in the US in patients stratified by age. Elderly patients are more likely to undergo open cholecystectomy. Laparoscopic cholecystectomy is associated with improved clinical outcomes. 1. Introduction It is well established that open cholecystectomy has worse outcomes than laparoscopic cholecystectomy [1–3]. In 1993, the National Institutes of Health (NIH) Consensus Conference on gallstones and laparoscopic cholecystectomy reported lower mortality, decreased disability, shorter LOS, and less patient discomfort with laparoscopic cholecystectomy in the general population and recommended laparoscopic cholecystectomy as the preferred surgical approach [2, 3]. It has been previously demonstrated that elderly patients are more likely to have more complex biliary disease and nearly six times greater odds of mortality following cholecystectomy than their younger counterparts [1–4]. As the proportion of population >65 years old is predicted to rise from 12% to 20% [1] over the next several decades, gallstone disease among the elderly will represent a major surgical burden. However, few studies have examined differences in rates of adoption of laparoscopic cholecystectomy among elderly patients compared with their younger counterparts. Few studies have examined differences in the adoption of laparoscopic cholecystectomy among elderly patients
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