AN EXTERNAL AUDIT OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE STEADY-STATEPERFORMED IN MEDICAL-TREATMENT FACILITIES OF THE DEPARTMENT-OF-DEFENSE

Objective This study provides the first objective assessment of a comp lete patient population undergoing laparoscopic cholecystectomy in the steady state. The authors determined the frequency of complications, particularly bile duct, bowel, vascular injuries, and deaths. Summary Background Data This retrospective study, conducted for the Department of Defense healthcare system by the Civilian External Peer Review Pro gram, is the second complete audit of laparoscopic cholecystectomy. Da ta were collected on 9130 patients undergoing laparoscopic cholecystec tomy between January 1993 and May 1994. Methods The study sample consi sted of clinical data abstracted from the complete records of 9054 (99 .2%) of the 9130 laparoscopic cholecystectomies performed at 94 milita ry medical treatment facilities. Results Of 10,458 cholecystectomies p erformed in the Military Health Services System, 9130 (87.3%) were lap aroscopic and 1328 (12.7%) were traditional open procedures. Seventy-s ix medical records were incomplete; however, there was sufficient data to determine mortality and bile duct injury rates. Of the remaining 9 054 cases, 6.09% experienced complications, including bile duct (0.41% ), bowel (0.32%), and vascular injuries (0.10 percent). The mortality rate was 0.13%. Access via Veress technique was used in 57.6% and Hass on technique in 42.4% of patients. Intraoperative cholangiograms were performed in 42.7% of the cases with a success rate of 86.2%. Eight hu ndred ninety-two (9.8%) patients were converted to open cholecystectom ies. Conclusions In the steady state, despite an increase in the perce ntage of laparoscopic cholecystectomies performed for nonmalignant gal lbladder disease, there continues to be minimal complications and low mortality.