Hospital volume and patient outcomes after cholecystectomy in Scotland: retrospective, national population based study

Dear Sir,

We read the aforementioned article with interest.

In particular, the finding of an association between certain quality measures in the provision of less complex surgical procedures such as cholecystectomy and hospital annual caseload mirrors the results of our analysis of English administrative data (Hospital Episode Statistics) from 2000-2008 (Surgical Endoscopy, in press) (1).

Our dataset included more than 400,000 cholecystectomy operations. Despite a 40% increase in the number of emergency admissions with biliary stone disease over the study period, the proportion of cholecystectomies performed as an emergency showed no increase with time.

We found that higher volume centres were almost 40% more likely to carry out cholecystectomy during an acute admission and were 10% more likely to complete such cases laparoscopically. This improved service provision was not associated with any detrimental outcomes (mortality, major bile duct injury or length of stay) in risk-adjusted logistic regression analyses.

We concur with the authors findings and re-iterate our own - that current provision of emergency cholecystectomy in England is sub-optimal and fails to adhere to the current recommended standard of care.

(1) Sinha S, Hofman D, Stoker D, Friend P, Poloniecki J, Thompson M, Holt P. Epidemiological study of provision of cholecystectomy in England from 2000 – 2009: retrospective analysis of Hospital Episode Statistics. Surgical Endoscopy [in press].