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

Am J Surg. 2015 Dec;210(6):1132-7; discussion 1137-9. doi: 10.1016/j.amjsurg.2015.07.009. Epub 2015 Sep 26.

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.

Keywords: Benchmarking; Choledocholithiasis; Laparoscopic cholecystectomy; Outcome reporting; Safety net hospital.

MeSH terms

  • Adult
  • Benchmarking*
  • Biliary Tract / diagnostic imaging
  • Biliary Tract / enzymology
  • Cholecystectomy, Laparoscopic*
  • Choledocholithiasis / diagnostic imaging
  • Choledocholithiasis / enzymology
  • Choledocholithiasis / surgery*
  • Dilatation, Pathologic
  • Female
  • Hospitals, Urban
  • Humans
  • Male
  • Retrospective Studies
  • Safety-net Providers
  • Treatment Outcome
  • Ultrasonography