SURGICAL RATES AND OPERATIVE MORTALITY FOR OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY IN MARYLAND

Background. Since 1989, laparoscopic cholecystectomy has been widely a dopted as a treatment for gallstone disease. We analyzed the associati on between the introduction of this procedure and three variables: the rate at which cholecystectomy was performed in Maryland, the characte ristics of patients undergoing cholecystectomy in routine clinical pra ctice, and operative mortality. Methods and Results. We used 1985-1992 hospital-discharge data from all 54 acute care hospitals in Maryland to identify open and laparoscopic cholecystectomies, characteristics o f patients undergoing these procedures, and deaths occurring during ho spitalizations in which these procedures were performed. The annual ra te of cholecystectomy, adjusted for age, rose from 1.69 per 1000 state residents in 1987-1989 to 2.17 per 1000 residents in 1992, an increas e of 28 percent (P<0.001). As compared with patients undergoing open c holecystectomy, patients undergoing laparoscopic cholecystectomy tende d to be younger, less likely to have acute cholecystitis or a common-d uct stone, and more likely to be white and have private health insuran ce or belong to a health maintenance organization (P<0.001). Although the operative mortality associated with laparoscopic cholecystectomy w as less than that with open cholecystectomy (adjusted odds ratio, 0.22 ; 95 percent confidence interval, 0.13 to 0.37) and the overall mortal ity rate for all cholecystectomies declined from 0.84 percent in 1989 to 0.56 percent in 1992, there was no significant change in the total number of cholecystectomy-related operative deaths because of the incr ease in the cholecystectomy rate. Conclusions. In Maryland, although t he adoption of laparoscopic cholecystectomy has been accompanied by a 33 percent decrease in overall operative mortality per procedure, the total number of cholecystectomy-related deaths has not fallen because of a 28 percent increase in the total rate of cholecystectomy.