Establishing benchmarks for the management of elevated liver enzymes and/or dilated biliary trees in an urban safety net hospital: analysis of 915 subjects

Abstract Background The push for public reporting of outcomes necessitates relevant benchmarks for disease states across different settings. This study establishes benchmarks for choledocholithiasis management in a safety net hospital setting. Methods We reviewed all patients admitted to our acute c...

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Bibliographic Details
Published in:The American journal of surgery 2015-12, Vol.210 (6), p.1132-1139
Main Authors: Liu, Laindy, B.A, Cripps, Michael W., M.D, Riggle, Andrew J., M.D, Wolf, Steven E., M.D, Nakonezny, Paul A., Ph.D, Phelan, Herb A., M.D., M.S.C.S
Format: Article
Language:English
Subjects:
Adult
Benchmarking
Bile
Biliary Tract - diagnostic imaging
Biliary Tract - enzymology
Cholecystectomy
Cholecystectomy, Laparoscopic
Choledocholithiasis
Choledocholithiasis - diagnostic imaging
Choledocholithiasis - enzymology
Choledocholithiasis - surgery
Cysts
Demographics
Dilatation, Pathologic
Disease
Endoscopy
Enzymes
Female
Gallbladder
Gallbladder diseases
Hospitals
Hospitals, Urban
Humans
Laparoscopic cholecystectomy
Male
Outcome reporting
Pathology
Patients
Retrospective Studies
Safety net hospital
Safety-net Providers
Studies
Surgery
Treatment Outcome
Ultrasonic imaging
Ultrasonography
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Summary:Abstract Background The push for public reporting of outcomes necessitates relevant benchmarks for disease states across different settings. This study establishes benchmarks for choledocholithiasis management in a safety net hospital setting. Methods We reviewed all patients admitted to our acute care surgery service with biochemical evidence of choledocholithiasis who underwent same-admission cholecystectomy (CCY) between July 2012 and December 2013. Results During this 18-month period, 915 patients were admitted with biochemical evidence of choledocholithiasis. Descriptive statistics for the cohort are provided, which include a 51% rate of obesity and 95% rate of pathologic cholecystitis. Conversion rates of 4% and complication rates of 6% were found. The majority had a CCY without biliary imaging (n = 630, 68.9%). Conclusions Relevant benchmarks are characterized, and results of a practice pattern of omitting pre- or intraoperative biliary tree imaging are described. These findings serve as a first benchmark of choledocholithiasis management for urban safety net hospitals.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2015.07.009