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Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis
BACKGROUND: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on m...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897463/ https://www.ncbi.nlm.nih.gov/pubmed/29556977 http://dx.doi.org/10.1007/s00464-017-5974-2 |
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author | Pucher, Philip H. Brunt, L. Michael Davies, Neil Linsk, Ali Munshi, Amani Rodriguez, H. Alejandro Fingerhut, Abe Fanelli, Robert D. Asbun, Horacio Aggarwal, Rajesh |
author_facet | Pucher, Philip H. Brunt, L. Michael Davies, Neil Linsk, Ali Munshi, Amani Rodriguez, H. Alejandro Fingerhut, Abe Fanelli, Robert D. Asbun, Horacio Aggarwal, Rajesh |
author_sort | Pucher, Philip H. |
collection | PubMed |
description | BACKGROUND: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI. METHODS: PubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates. RESULTS: One hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6–5.3%, 0.32–0.52%, and 0.08–0.14%, respectively. Reported BDI rates reduced over time (1994–1999: 0.69(0.52–0.84)% versus 2010–2015 0.22(0.02–0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified. CONCLUSIONS: Overall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-017-5974-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5897463 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-58974632018-04-16 Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis Pucher, Philip H. Brunt, L. Michael Davies, Neil Linsk, Ali Munshi, Amani Rodriguez, H. Alejandro Fingerhut, Abe Fanelli, Robert D. Asbun, Horacio Aggarwal, Rajesh Surg Endosc Review BACKGROUND: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI. METHODS: PubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates. RESULTS: One hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6–5.3%, 0.32–0.52%, and 0.08–0.14%, respectively. Reported BDI rates reduced over time (1994–1999: 0.69(0.52–0.84)% versus 2010–2015 0.22(0.02–0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified. CONCLUSIONS: Overall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-017-5974-2) contains supplementary material, which is available to authorized users. Springer US 2018-03-19 2018 /pmc/articles/PMC5897463/ /pubmed/29556977 http://dx.doi.org/10.1007/s00464-017-5974-2 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Review Pucher, Philip H. Brunt, L. Michael Davies, Neil Linsk, Ali Munshi, Amani Rodriguez, H. Alejandro Fingerhut, Abe Fanelli, Robert D. Asbun, Horacio Aggarwal, Rajesh Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
title | Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
title_full | Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
title_fullStr | Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
title_full_unstemmed | Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
title_short | Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
title_sort | outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897463/ https://www.ncbi.nlm.nih.gov/pubmed/29556977 http://dx.doi.org/10.1007/s00464-017-5974-2 |
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