Time trend and variability of open versus laparoscopic cholecystectomy in patients with symptomatic gallstone disease.

ABSTRACT

BACKGROUND: The purpose of this study was to compare length of stay, as one of the efficacy indicators, and effectiveness, in terms of operative complications and mortality, between laparoscopic (LC) and open cholecystectomy, and to verify the 10-year temporal trends in the application of the LC technique in a large regional population. METHODS: This was a retrospective cohort study based on 73,853 hospital discharge records of cholecystectomies for gallstone disease (GD) in residents of the Veneto from 2001 to 2010, at both public and accredited private hospitals. The data are from a regional administrative database. The main epidemiological rates calculated, and expressed per 100,000 residents, were the cholecystectomy rate (CR) for gallstones by surgical technique (laparoscopic or open surgery), and the in-hospital mortality rate (MR), considered as the in-hospital MR regardless of the specific cause of death. RESULTS: The CR was 139.7 higher in females, with a male-to-female ratio of 11.5. LC was performed more frequently in females than in males and in younger than in older patients. From 2001 to 2010, there was a significant linear rising trend in the use of LC, in fact during the period considered, the use of laparoscopic surgery increased significant (χ (2) trend 316,917; p < 0.05), reaching 93.6% of surgical procedures for gallstones during the year 2010. CONCLUSIONS: There are still some age- and gender-related disparities in its usage, although LC is an increasingly widely applied, as effective procedure.