THE IMPACT OF LAPAROSCOPIC CHOLECYSTECTOMY ON THE MANAGEMENT AND OUTCOME OF BILIARY-TRACT DISEASE IN NORTH-CAROLINA - A STATEWIDE, POPULATION-BASED, TIME-SERIES ANALYSIS

BACKGROUND: Laparoscopic cholecystectomy (LC) has had a major impact o n the treatment of patients with biliary tract disease, but the magnit ude and the details of its effects on biliary surgery remain incomplet ely described. The purpose of this study was to perform a statewide, p opulation-based, time-series analysis of the effects of LC on biliary surgery. STUDY DESIGN: Patient data were obtained from the statewide h ospital discharge database that collects data from all 157 hospitals i n the state of North Carolina. All patients with hospital admissions f or biliary tract disease from 1988 through 1993 were selected for anal ysis. RESULTS: The use of open cholecystectomy (OC) dropped from 100 p ercent of all cholecystectomies in 1988 to 32.3 percent in 1993, while LC increased from eight cases in 1988 to over 7,800 per year in 1993. The increase in the rate of LC was not associated with an increase in the overall rate of cholecystectomy. Bile duct (ED) repairs increased from 13 in 1988 to a high of 36 in 1992. There was a strong; statisti cally significant correlation between the rate of LCs and the rate of ED repairs (R=0.89, p=0.0001). Hospital charges and component charges were lower for patients having elective LC compared to those having el ective OC (p=0.001). This remained true after stratification by age an d type of gallbladder disease. Hospital stays were shorter for patient s having LC than for those having OC (p=0.001 for all). Surgeons in sm aller hospitals were slower at adopting LC. Younger and board certifie d surgeons adopted LC more rapidly than older and non-board certified surgeons. CONCLUSIONS: In North Carolina, LCs progressed from nonexist ent to the dominant approach for managing patients with cholelithiasis in a matter of a few years. Associated with this change were shorter hospitalizations and lower charges. Contrary to other published report s, North Carolina did not experience an increase in the overall rate o f cholecystectomy with the adoption of LC. There was a highly correlat ed increase in the rate of bile duct repairs in the first years of the study.