Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases
Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases
Background: the aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods: data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results: data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2 , who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion: patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
Adult, Aged, Aged, 80 and over, Cholecystectomy/statistics & numerical data, Emergency Treatment, Female, Gallbladder Diseases/surgery, Hospitalization/statistics & numerical data, Hospitals/statistics & numerical data, Humans, Ireland, Male, Middle Aged, Prospective Studies, Time-to-Treatment, United Kingdom
1716-1726
Byrne, James
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Hamady, Zaed
545a1c81-276e-4341-a420-aa10aa5d8ca8
CholeS Study Group, West Midlands Research Collaborative
November 2016
Byrne, James
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Hamady, Zaed
545a1c81-276e-4341-a420-aa10aa5d8ca8
CholeS Study Group, West Midlands Research Collaborative
(2016)
Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases.
The British journal of surgery, 103 (12), .
(doi:10.1002/bjs.10288).
Abstract
Background: the aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods: data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results: data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2 , who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion: patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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More information
Accepted/In Press date: 6 July 2016
e-pub ahead of print date: 17 October 2016
Published date: November 2016
Keywords:
Adult, Aged, Aged, 80 and over, Cholecystectomy/statistics & numerical data, Emergency Treatment, Female, Gallbladder Diseases/surgery, Hospitalization/statistics & numerical data, Hospitals/statistics & numerical data, Humans, Ireland, Male, Middle Aged, Prospective Studies, Time-to-Treatment, United Kingdom
Identifiers
Local EPrints ID: 485411
URI: http://eprints.soton.ac.uk/id/eprint/485411
PURE UUID: 3ab79592-73c6-44a1-9e3e-72a49f299d3f
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Date deposited: 06 Dec 2023 17:34
Last modified: 17 Mar 2024 04:12
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Contributors
Author:
James Byrne
Author:
Zaed Hamady
Corporate Author: CholeS Study Group, West Midlands Research Collaborative
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