Laparoscopic and open cholecystectomy outcomes in Medicare beneficiaries in member states of the Large State PRO Consortium

Abstract

To determine the incidence of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) and some of their possible outcomes (complications, mortality, 30-day readmission) in the general population of senior citizens, we examined Medicare claims data for beneficiaries 65 years and older in eight states. Billing data for all cholecystectomies (ICD9-CM 51.22, 51.23) performed on an inpatient basis in those states on Medicare beneficiaries age 65 and older during fiscal year 1992 were examined. The incidence of LC in each state ranged from 2.1 to 3.2/1,000, whereas the incidence of OC ranged from 2.2 to 3.5/1,000. Eleven and one-half percent of LC patients suffered at least one perioperative complications, as did 21.5% of OC patients. There was considerable interstate variation in complication rates. In-hospital mortality was about five times greater of OC (4.5%) than for LC (0.9%). Patients who underwent OC were more likely (9.2%) to be readmitted within 30 days than were LC patients (7.0%). LC seems to be at least as safe as OC in the elderly population. Analyzing Medicare claims data can be useful in uncovering geographic variations in cholecystectomy practice.