Date of Award

January 2012

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Julie A. Sosa

Subject Area(s)

Surgery

Abstract

SURGEON VOLUME TRUMPS SPECIALTY: OUTCOMES FROM 3,596 PEDIATRIC CHOLECYSTECTOMIES

Kesi Chen, Kevin Cheung (Department of Surgery, McMaster University, Hamilton, ON, Canada), Julie Ann Sosa. Department of Surgery, Yale University, School of Medicine, New Haven, CT.

Laparoscopic cholecystectomy is the standard surgical management of biliary disease in children, but there has been a paucity of studies addressing outcomes after pediatric cholecystectomies, particularly on a national level. This is the first study to address the effect of surgeon specialty and volume on clinical and economic outcomes after pediatric cholecystectomies on a population level.

We conducted a retrospective cross-sectional study using the Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS). Children (17 yrs and younger) who underwent laparoscopic cholecystectomy from 2003-2007 were selected. Pediatric surgeons performed >90% of their total cases in children. High-volume surgeons were in the top tertile (N>37/year) of total cholecystectomies performed.

Chi-square, ANOVA, and multivariate linear and logistic regression analyses were used to assess in-hospital complications, median length of hospital stay (LOS), and total hospital costs (2007 dollars).

A total of 3,596 pediatric cholecystectomies were included. Low-volume surgeons had more complications, longer LOS, and higher costs than high-volume surgeons. After adjustment in multivariate regression, surgeon volume, but not specialty, was an independent predictor of LOS and cost.

High-volume surgeons have better outcomes after pediatric cholecystectomy than low-volume surgeons. Surgeon specialty was not predictive of outcomes. To optimize outcomes in children after cholecystectomy, surgeon volume and laparoscopic experience should be considered above surgeon specialty.

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