High-volume general surgeons do well in pediatric laparoscopic cholecystectomy

Last Updated: 2018-01-24

By David Douglas

NEW YORK (Reuters Health) - Surgical volume may have a greater effect on children's outcomes after laparoscopic cholecystectomy than does specialty training in the field, according to research from Canada.

Dr. Dennis Hong told Reuters Health by email, "Adult surgeons who do a lot of gallbladder surgery can safely do gallbladder surgery in kids. In fact, they do a better job than low-volume pediatric surgeons."

In their January 17 online article in JAMA Surgery, Dr. Hong of McMaster University, Hamilton, Ontario, and colleagues note that, although once rare, "the prevalence of pediatric cholelithiasis has increased with the epidemic of childhood obesity."

To examine factors associated with the costs and outcomes of pediatric laparoscopic cholecystectomy, the team retrospectively examined data on more than 3,500 children (median age, 15 years; 79% female) who had undergone the procedure from 2008 to 2015.

The overall morbidity rate was 3.9%; after adjustment, patients with comorbidities had a higher morbidity rate than their healthy counterparts (9.4% vs. 2.5%). The most common comorbidities were consequences of gallstone disease, including cholecystitis, choledocholithiasis, and biliary pancreatitis.

A high-volume surgeon was defined as one who had completed 50 or more laparoscopic cholecystectomies during the 7-year study period. There was no association between comorbidity status and whether or not a patient received care by a pediatric or a general surgeon. However, more than half of the cholecystectomies (53.9%) were performed by high-volume general surgeons.

Compared with low-volume pediatric surgeons, high-volume general surgeons had significantly lower morbidity rates (odds ratio, 0.32).

The mean unadjusted cost of the procedure was C$4,115 (US$3,300). Cost did not differ significantly between low-volume general surgeons and high-volume pediatric surgeons, but procedures by high-volume general surgeons cost an average of C$1,970 (US$1,580) less than those by their low-volume pediatric counterparts.

"As the rate of pediatric gallstone disease increases," the investigators conclude, "surgeon volume, rather than specialty training, should be considered when pursuing operative management."

Coauthor of an accompanying editorial Dr. Lorraine Kelley-Quon, an assistant professor of surgery at Children's Hospital Los Angeles, told Reuters Health by email, "A substantial number of surgeries done in children and adolescents are performed by general surgeons."

"Integrating the general surgeon into the broader conversation of improving value in children's surgery," she concluded, "is a novel concept and deserves further exploration and study."

SOURCES: http://bit.ly/2DpQqmv and http://bit.ly/2BgxqAX

JAMA Surg 2018.