TOPLINE:

Among Medicare beneficiaries who underwent minimally invasive cholecystectomy from 2011 to 2021 as inpatients, surgical safety improved substantially, with rates of complications — such as bile duct injury and intraoperative hemorrhage — decreasing. However, the use of postoperative percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) increased notably during this period.

METHODOLOGY:

• Cholecystectomy is a common operation, with overall morbidity reported at 10%-20% and bile duct injury occurring in approximately 0.3% of patients; however, longitudinal data on outcomes in inpatients undergoing minimally invasive cholecystectomy in the US have been limited.
• Researchers conducted a retrospective cohort study using Medicare fee-for-service claims data from 2011 to 2021 to evaluate changes in outcomes and complications following inpatient minimally invasive cholecystectomy in the US.
• They included 516,372 Medicare beneficiaries (mean age, 74.8 years; 52.4% female) who underwent minimally invasive (laparoscopic or robotic) cholecystectomy and were identified using diagnostic and procedure codes.
• Outcome measures covered length of stay, 30‑day readmission, complications, serious complications (defined as the occurrence of complications plus a length of stay greater than the 75th percentile), 30‑day mortality, and in‑hospital mortality.
• Complications included intraoperative hemorrhage, the need for postoperative blood transfusion, percutaneous abdominal drainage, urinary tract infection, and deep venous thrombosis; ERCP within 1 year; and bile duct injury requiring surgical repair with hepaticojejunostomy or choledochojejunostomy within 1 year.

TAKEAWAY:

• Adjusted rates of overall complications decreased from 21.5% (95% CI, 21.3%-21.7%) in 2011 to 16.5% (95% CI, 16.4%-16.7%) in 2021, and those of serious complications declined from 12.3% (95% CI, 12.2%-12.5%) to 7.0% (95% CI, 6.9%-7.1%) during the same period (P < .001 for both).
• From 2011 to 2021, risk-adjusted rates of intraoperative hemorrhage decreased by nearly half, from 1.07% to 0.54% (P < .001); those of blood transfusion dropped from 5.47% to 1.87% (P < .001); and those of bile duct injury declined from 0.19% to 0.12% (P = .001 ).
• Risk-adjusted rates of postoperative percutaneous drainage increased from 1.32% (95% CI, 1.26%-1.37%) to 2.91% (95% CI, 2.81%-3.01%), and the use of ERCP within 1 year rose from 11.21% to 15.26% (P < .001 for both).

IN PRACTICE:

“These findings reflect the progress made through collective surgical quality improvement efforts and offer a road map for future initiatives, such as understanding the growing use of postoperative percutaneous drainage and ERCP, to continue improving the safety of cholecystectomy,” the authors of the study wrote.

The authors of an invited commentary added, “Mullens and colleagues present a timely and encouraging study highlighting the evolution of postoperative outcomes following inpatient minimally invasive cholecystectomy.”

SOURCE:

The study was led by Cody Lendon Mullens, MD, MPH, MS, University of Michigan, Ann Arbor, Michigan. It was published online in JAMA Surgery.

LIMITATIONS:

The results are likely affected by adverse selection bias given the inpatient setting studied, potentially underestimating the actual quality improvements in outcomes. Residual confounding remains possible despite robust adjustment and secular trend data. The 2020-2021 period could reflect pandemic effects.

DISCLOSURES:

The study did not report any specific funding. One author disclosed receiving personal fees from JAMA Network for visual abstract editing and support from the National Institutes of Health/National Institute on Minority Health and Health Disparities Loan Repayment Program outside the submitted work. Another reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.