POSTOPERATIVE COMPLICATIONS OF CHOLECYSTECTOMY IN VICTORIAN PUBLIC HOSPITALS

Cholecystectomies in Victorian public hospitals were evaluated by anal ysis of hospital morbidity data. The Victorian Inpatient Minimum Datas et (VIMD) contains data on postoperative complications from all cholec ystectomies in Victorian public hospitals. Hospital separations associ ated with cholecystectomy were identified according to Australian nati onal diagnosis-related groups and tile procedures were grouped as open , laparoscopic or conversion from laparoscopic to open cholecystectomy (conversion). Postoperative complications were identified by ICD9-CM external-cause codes (E-codes) in the VIMD. The 35593 cholecystectomie s performed between 1987-88 and 1993-94 were analysed. A further detai led analysis of all cholecystectomies performed in 1993 was based on l ogistic regression. This identified the adjusted odds (AOR) of occurre nce of complications and included covariates of age, sex, admission ty pe, diagnosis-related group and hospital identification code. The annu al frequency of cholecystectomy increased after introduction of laparo scopic cholecystectomy in 1990, and was associated with an increase in rates of separations having adverse events, but laparoscopic cholecys tectomy had the lowest rate (66.7 per 1000 separations). Adverse-event rates for open procedures increased to 157.5 per 1000 in 1993-94, and for conversions to 290.0 per 1000. Of 5627 cholecystectomies in 1993, 74.4 per cent were laparoscopic, 21.5 per cent open and 4.1 per cent conversions. Postoperative complications were more likely in males (AO R 1.67, 95 per cent confidence interval (CI) 1.38 to 2.04), in patient s admitted as an emergency (1.27, CI 1.01 to 1.60), and in those havin g open cholecystectomies (2.25, 1.78 to 2.85) or conversions (4.29, 3. 05 to 6.03). Analysis of the VIMD has provided information for the eva luation of cholecystectomy. The VIMD is a useful tool for monitoring p ostoperative complications and the quality of care in Victorian hospit als.