Laparoscopic and Open Cholecystectomy Outcomes in Medicare Beneficiaries in Member States of the Large State PRO Consortium

To determine the incidence of laparoscopic cholecys tectomy (LC) and open cholecystectomy (OC) and some of their possible outcomes (complications, mortality, 30-day readmission) in the general population of senior citizens, we examined Medicare claims data for benefici aries 65 years and older in eight states. Billing data for all cholecystectomies (ICD9-CM 51.22, 51.23) per formed on an inpatient basis in those states on Medicare beneficiaries age 65 and older during fiscal year 1992 were examined. The incidence of LC in each state ranged from 2.1 to 3.2/1,000, whereas the incidence of OC ranged from 2.2 to 3.5/1,000. Eleven and one-half percent of LC patients suffered at least one periopera tive complication, as did 21.5% of OC patients. There was considerable interstate variation in complication rates. In-hospital mortality was about five times greater for OC (4.5%) than for LC (0.9%). Patients who under went OC were more likely (9.2%) to be readmitted within 30 days than were LC patients (7.0%). LC seems to be at least as safe as OC in the elderly population. Analyzing Medicare claims data can be useful in uncov ering geographic variations in cholecystectomy practice.