THE OUTCOMES OF ELECTIVE LAPAROSCOPIC AND OPEN CHOLECYSTECTOMIES

BACKGROUND: The demand for evidence of effectiveness for medical care has prompted the development of epidemiologic approaches to relating t he outcomes of care to treatment. This study compares the outcomes of care for patients undergoing the newly introduced laparoscopic cholecy stectomy with the results from conventional open cholecystectomies. ME THODS: Consecutive cases of elective cholecystectomy from 35 hospitals (all of the metropolitan and selected rural hospitals in Minnesota) w ere enrolled in the study. Patients were interviewed on admission to e stablish baseline symptoms and functional status and to confirm risk f actors. Their medical records were abstracted to yield information on risk factors, treatment, and hospital complications. To establish outc omes, patients were sent a questionnaire about their symptoms and func tional status six months postoperatively. RESULTS: Of 3,448 patients s tudied, 2,490 (72 percent) had a laparoscopic procedure, including 195 cases that were converted to open cholecystectomies. Functional statu s data were obtained on 2,481 cases (76 percent). Laparoscopic operati on was associated with more operative complications (odds ratio 3.02, p<0.001), but with fewer general complications (odds ratio 0.32, p<0.0 01). The mean time to return to work was 15 days for laparoscopic case s compared to 31 days for open procedures (p<0.001). The only function al outcome difference between the two procedures was that patients who underwent laparoscopic cholecystectomies were more likely than those with conventional cholecystectomies to be able to perform their usual activities at follow-up evaluation (p<.001). There was evidence of a l earning curve; the more laparoscopic procedures a surgeon performed, t he fewer the operative (p<0.01) and general (p<0.0001) complications. There was no indication that the availability of laparoscopic operatio n was associated with more operations being performed. CONCLUSIONS: La paroscopic operation seems to represent a significant advance in getti ng patients back to a normal life sooner. More attention needs to be g iven to which patients are most likely to benefit from cholecystectomy of either type, Epidemiologic approaches can be useful in assessing t he effectiveness of care. Partnerships between providers and researche rs can produce useful effectiveness data by supplementing available cl inical records with more detailed outcome data.