Abstract
The management of gallstone disease has evolved over time and includes laparoscopic and open cholecystectomy, interventional radiology, endoscopic intervention and conservative management. Subspecialisation within general surgery is commonplace, allowing development of specialist skillsets. The aim of this study is to assess the impact of consultant subspecialisation on patient outcomes in those admitted with gallstone disease.
A retrospective cohort study - data was collected on patients admitted with gallstone disease in the North of England between 2002 and 2016. Subspecialisation was categorised as Upper GI or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach and length of stay.
A total of 62,286 patients were admitted with gallstone disease. Overall 30-day mortality was 2.1%. The UGI specialists had a higher operative rate - 21.5% vs 10.7% (<0.001) than their colleagues including performing more laparoscopic cholecystectomies– 15.6% vs 6.4% (<0.001), and on-table cholangiogram (OTC) – 3.5% vs 1.5% (p < 0.001).
22,071 patients were diagnosed with acute cholecystitis. Non-UGI Consultants preferred conservative management (76.5% vs 59.0% - p < 0.001) which did not significantly affect 30-day mortality. Data was analysed using IBM SPSS Statistics. Categorical data were compared with chi-square test, and continuous data with t-test or ANOVA. Statistical significance was defined as a p value of ≤ 0.05.
UGI consultants performed significantly more “hot gallbladders” than their non-UGI counterparts. UGI consultants choose to operate laparoscopically and perform significantly more OTCs, likely reducing need for pre-operative MRCP but not significantly reducing overall 30-day mortality or length of stay.
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