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Regional variations in the treatment of gallstone disease may affect patient outcome: A large, population-based register study in sweden
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.ORCID iD: 0000-0003-1732-168X
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2021 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 110, no 3, p. 335-343Article in journal (Refereed) Published
Abstract [en]

Background: The lack of studies showing benefit from surgery in patients with symptoms of gallstone disease has led to a divergence in local practices and standards of care. This study aimed to explore regional differences in management and complications in Sweden. Furthermore, to study whether population density had an impact on management.

Methods: Data were collected from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Cholecystectomies undertaken for gallstone disease between January 2006 and December 2017 were included. Age, sex, American Society of Anesthesiologists (ASA) classification, intra- and post-operative complications, and the proportion of patients with acute cholecystitis who underwent surgery within 2 days of hospital admission were analyzed. The 21 different geographical regions in Sweden were compared, and each variable was analyzed according to population density.

Results: A total of 139,444 cholecystectomies cases were included in this study. There were large differences between regions regarding indications for surgery and intra- and post-operative complications. In the analyses, there were greater divergences than would be expected by chance for most of the variables analyzed. Age of the cholecystectomized patients correlated with population density of the regions (R2 = 0.310; p = 0.0088).

Conclusion: There are major differences between the different regions in Sweden in terms of the treatment of gallstone disease and outcome, but these did not correlate to population density, suggesting that local routines are more likely to have an impact on treatment strategies rather than demographic factors. These differences need further investigation to reveal the underlying causes.

Place, publisher, year, edition, pages
Sage Publications, 2021. Vol. 110, no 3, p. 335-343
Keywords [en]
Gallstone, cholecystectomy, cholecystitis, regional differences, population density, complications
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-176872DOI: 10.1177/1457496920968015ISI: 000586001100001PubMedID: 33106126Scopus ID: 2-s2.0-85094617762OAI: oai:DiVA.org:umu-176872DiVA, id: diva2:1502132
Available from: 2020-11-19 Created: 2020-11-19 Last updated: 2024-04-09Bibliographically approved

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Lindqvist, LisaNordin, PärHemmingsson, OskarEnochsson, Lars

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