Surgeon Procedure Volume Strongly Associated with Adverse Events Post Laparoscopic Cholecystectomy

Yazen Qumsiyeh¹, Curtis T Adams, MD¹, Sean Wrenn, MD², Ashley Deeb¹, Charles Maclean, MDCM, FACP³, Wasef Abu-Jaish, MD, FACS, FASMBS². ¹University of Vermont Larner College of Medicine, ²University of Vermont Medical Center, Department of Surgery, ³University of Vermont Medical Center, Department of medicine

Introduction: Recent studies have reported mixed outcomes when comparing surgeon case volume and Laparoscopic Cholecystectomy (LC) outcomes. Formal minimally invasive surgical training (MIST) has been shown to be associated with shorter post-operative length of stay (LOS), but no difference in major adverse events such as bile leak, bile duct injury, intra-abdominal abscess formation, and death. We aim to determine 30-day rates of major adverse events after LC in a university hospital setting, to identify significant associated risk factors, and to determine if MIST or surgeon volume are associated with differences in LOS and major adverse events.

Methods: We conducted a single-center retrospective review of 2,764 cholecystectomies performed over a seven-year period (2009-2016). Characteristics and outcomes were compared using Chi squared or rank sum tests. Multivariable regression modeling was used to determine independent associations with the two main outcomes, major adverse events and LOS.

Results: We identified 2,764 adults who underwent LC during the study period, with a median age of 50, and 70% women. About 19% (n=531) of patients had a LOS >1 day and 4.3% (n=120) were re-admitted within the first 30 days after surgery for any reason. Within 30 days of LC, 2.2% (n=60) of patients suffered from one or more major adverse events. This includes 0.18% (n=5) of patients with bile duct injury, 1.3% (n=35) of patients with bile leak, 0.3% (n=7) of patients with intra-abdominal abscess, and 0.3% (n=9) of patients died for reasons related to their procedure or post-operative recovery. Table 1 shows the characteristics of the patients and procedures with a comparison of the patients with an adverse event versus those without one. In univariate analysis, high annual surgical volume (40+ cases/year) and procedure urgency were found to be significant predictors of adverse events and LOS, however, MIST was not. In multivariable analysis, controlling for significant univariate predictors, urgent or emergent cases were associated with a 3-fold increase in odds of an adverse event (OR=3.0 [CI 1.7, 5.1]) and high surgical volume with a significantly lower risk (OR=0.37 [CI 0.2, 0.8]. For the LOS outcome, procedure urgency (OR=45 [CI 33, 61]) and surgeon volume (OR=0.4 [CI .03, 0.6]) were also the strongest predictors.

Conclusion: Our adverse events rate from LC falls below the range of recently published data. After controlling for clinical covariates, procedure urgency and surgeon case volume were the strongest predictors of adverse events and LOS, whereas MIST was not.

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 84994

Program Number: P124

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster