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Surgeon volume plays a role in successful gallbladder surgery in children
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Child patients who underwent laparoscopic cholecystectomies experienced better morbidity rates when their procedure was performed by a general adult surgeon, according to a study published in JAMA Surgery.
Gilly-Gol Akhtar-Danesh , BSHc, MD, of the department of surgery at McMaster University in Hamilton, Ontario, Canada, and colleagues wrote that general adult surgeons also corresponded with a lower cost procedure compared with low-volume pediatric surgeons.
“Overall, the importance of our study is that it highlights that general surgeons can safely perform gallbladder surgery in children, and that subspecialty training in pediatrics does not seem to influence outcomes of gallstone disease,” Akhtar-Danesh told Healio Gastroenterology and Liver Disease.
Akhtar-Danesh and colleagues conducted a retrospective, population-based study of children aged 17 years and younger who underwent laparoscopic cholecystectomy between April 2008 and March 2015 to determine the factors associated with morbidity and cost of the surgery.
The researchers identified 3,519 patients who underwent the surgery during the study period and found that the overall morbidity rate was 3.9% (n = 137). They determined that operative indication and patient comorbidities increased morbidity in the patients.
Akhtar-Danesh and colleagues noted that while these factors cannot be modified, they found that surgeon volume had a significant impact on morbidity rates in the patients.
High-volume adult surgeons had lower morbidity rates compared with low-volume pediatric surgeons (OR = 0.32; 95% CI, 0.12–0.69). They were also able to perform laparoscopic cholecystectomies for the lowest cost, $2,615 less than the mean price (95% CI, –3,369 to –1860,).
Akhtar-Danesh said the findings indicate that surgeon volume, rather than specialty training needs to be an important consideration when it comes to patient safety, as well as from an economic perspective.
“Our study, actually suggests that adult general surgeons have better outcomes than low-volume pediatric surgeons, suggesting that significantly higher volume of gallstone disease encountered by adult general surgeons translates to better outcomes in the pediatric population,” Akhtar-Danesh said. “We hope that these findings will prompt a broader discussion on how adult general surgeons can add value to the surgical care of children.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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