INTER-HOSPITAL VARIABILITY AND TRENDS IN CHOLECYSTECTOMY RATES FOR BILIARY COLIC: A NATIONAL PERSPECTIVE FROM 2012 TO 2019
Methods: We conducted a retrospective analysis of National Inpatient Sample (NIS) data from 2012 to 2019, post-adjustment for the revised NIS sampling methodology and excluding COVID-19 pandemic impacts. The study examined hospitalizations with primary diagnoses of BC, alongside those with primary diagnoses of uncomplicated cholecystitis (UC) for comparison. Diagnostic and procedural codes, aligned with Agency for Healthcare Research and Quality (AHRQ) Quality Indicator standards (e.g., ICD-9 57.420, ICD-10 K80.20 for BC), identified cases. Exclusions included patients under 18 and hospitals with no CCY performance or bottom 10th percentile annual BC/UC diagnosis volumes. We calculated age and gender-adjusted CCY rates (AGA-CCYR) for each hospital and assessed inter-hospital variability using factor scores—ratios of mean AGA-CCYR between the top and bottom 5% of hospitals. Linear regression analyzed trends.
Results: Annually, between 878 and 1,304 hospitals were included in BC analysis, encompassing an accumulation of 182,085 hospitalizations, 67.5% of which were female. The median patient age at BC hospitalization was 55 (interquartile range: 38-70). The mean AGA-CCYR for BC was 27.5%, with a median of 24.3%, lower than UC (62.3% and 67.0%). The average factor score in BC was 11.9, higher than that of overall UC (7.4). Trends in AGA-CCYR at individual hospitals in BC and UC are depicted in Figure 1. In BC, a significant decrease was noted in mean AGA-CCYR (beta-coefficient: -0.6%, 95% CI: -0.8% to -0.4%, P <0.001), contrasting with the stable median rates (-0.2%, 95% CI: -0.5% to 0.2%, P=0.365). The factor score remained unchanged (-0.03, CI: -0.17 to 0.12, P =0.716). In UC, both mean (beta-coefficient: -1.3%, 95% CI: -1.4% to -1.1%, P <0.001) and median (beta-coefficient: -1.7%, 95% CI: -1.9% to -1.5%, P<0.001) AGA-CCYR exhibited significant declines, with the factor score showing no significant change (0.13, CI: -0.03 to 0.28, P =0.096). These trends for both BC and UC are depicted in Figure 2.
Conclusion: CCY decision-making in BC involves multifaceted considerations, including clinical presentation, patient characteristics, and physician discretion. Our study reveals a notable decline in CCY rates for BC from 2012 to 2019, accompanied by persistent inter-hospital variability. This variability in CCY rates, more pronounced than in UC, highlights divergent clinical practices among hospitals in the care of BC. Understanding these disparities is crucial for developing unified, evidence-based guidelines for BC management.
Figure 1. Age and Gender Adjusted Cholecystectomy Rates in Hospitals for Biliary Colic and Uncomplicated Cholecystitis (2012-2019).
This figure presents scatter plots of age and gender-adjusted cholecystectomy rates in individual hospitals over the years for biliary colic (A) and uncomplicated cholecystitis (B). Each dot represents a hospital's adjusted rate for a given year. The dots are color-coded in a grayscale gradient to reflect the year, with lighter shades denoting earlier years (starting from 2012) and progressively darker shades for subsequent years. Hospital IDs, sorted annually by their CCY volume from lowest to highest, vary each year, precluding longitudinal tracking of specific hospitals.
Figure 2. Longitudinal Analysis of Age and Gender Adjusted Rates and Hospital Variability of Cholecystectomy for Biliary Colic and Uncomplicated Cholecystitis (2012-2019).
This figure comprises two panels, illustrating the yearly trends in cholecystectomy rates and inter-hospital variability for biliary colic (A) and uncomplicated cholecystitis/cholelithiasis (B) over 2012-2019. Solid lines in each panel represent annual data points, while dashed lines indicate linear trends. Utilizing dual y-axes, the figure concurrently displays mean and median rates, along with factor scores denoting hospital variation. Boxes within each panel detail linear regression parameters for each metric.
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