Variation in Practice and Outcomes of Cholecystectomy Across New Zealand (CHOLENZ): A Prospective National Cohort Study

Authors List

STRATA Collaborative

Introduction: Outcomes after acute, delayed, and elective cholecystectomy vary. Early cholecystectomy for benign biliary disease is associated with fewer readmissions and complications. Current experience in Aotearoa New Zealand with regards to timing and outcomes is unknown.

Aims
: Firstly, to determine the variation in the rates of acute index cholecystectomy in Aotearoa New Zealand, and secondly, to compare all-cause readmissions and complications within 30-days of acute, delayed and elective cholecystectomy.

Methods
: A multicentre, prospective, national cohort study of cholecystectomy for benign disease was conducted by STRATA, a student- and trainee-led collaborative network. Data were collected on consecutive patients undergoing cholecystectomy in New Zealand hospitals between 1 August and 30 October 2021 with 30-day follow-up. Descriptive statistics and funnel plots were used to determine national variation in practice. Logistic regression was used to identify predictors of readmission and complications.

Results
: Data were collected from 1170 patients in 16 hospitals. Of these, 723 (61.8%) were performed as an acute operation at index admission, 182 (15.6%) were delayed operations following previous admission, and 258 (22.1%) were performed as an elective operation with no preceding acute admissions. Rates of acute index cholecystectomy varied from 17% to 87%. At 30-days the readmission rate was 7.6% (87 of 1151 with complete data) and the complication rate was 19.2% (222 of 1156). These rates were not significantly different between patients having acute, delayed, or elective cholecystectomy after adjusting for confounders (all p > 0.1). Bile leak occurred in 2.3% (27 of 1170), and a bile duct injury occurred in 0.34% (4 of 1170).

Conclusions
: There was notable variation in the rate of acute index cholecystectomy, the reasons for which need to be determined. Readmission and complications were common but comparable between patients having acute, delayed, and elective cholecystectomy; and the international literature.

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