Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics
Background The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome. Methods The Hospital Episode Statistics databas...
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| Veröffentlicht in: | Surgical endoscopy 2013, Vol.27 (1), p.162-175 |
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| creator | Sinha, Sidhartha Hofman, David Stoker, David L. Friend, Peter J. Poloniecki, Jan D. Thompson, Matt M. Holt, Peter J. E. |
| description | Background
The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome.
Methods
The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay.
Results
A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3 %) cases and increased by 14.6 % over the study period. The in-patient mortality rate (0.2 %), 1 year mortality rate (1 %), proportion of cases converted to open (5.0 %), major BDI rate (0.4 %), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5 %) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.35–1.44) and specialist units (OR 1.32, 95 % CI 1.30–1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95 % CI 1.05–1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes.
Conclusions
The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes. |
| doi_str_mv | 10.1007/s00464-012-2415-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1273744315</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1273744315</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-5d0a6b7be0ed0f8324ad85f3f8800618f62e9237a7fb1eb2de806e59f77fc3063</originalsourceid><addsrcrecordid>eNp1kUGL1TAUhYMoznP0B7iRgBs31ZukbVJ3MjwdYWAWM65Dmtw8M7TNs0kH-hP816a-UUSY1eUm3z2HwyHkNYP3DEB-SAB1W1fAeMVr1lTwhOxYLcrGmXpKdtAJqLjs6jPyIqU7KHjHmufkjHMFbQPdjvzcH4PDMcQhHoI1A015cSuNnh7neB9SiNO22O9xQLumjDbHcaVhovvpMJjJUT_HkfKiTXPcZveRzpjnmI6FDfdIzWSGNYW06VyW55CLTbFN0SG9ySaHlINNL8kzb4aErx7mOfn2eX97cVldXX_5evHpqrJC8lw1Dkzbyx4BHXgleG2carzwSgG0TPmWY8eFNNL3DHvusETFpvNSeiugFefk3Um3BPyxYMp6DMniUMJgXJJmXApZ14I1BX37H3oXl7nE-U2BEEpKVSh2omwJnWb0-jiH0cyrZqC3nvSpJ1160ltPGsrNmwflpR_R_b34U0wB-AlI5Ws64PyP9aOqvwCPxZ4X</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1270338778</pqid></control><display><type>article</type><title>Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Sinha, Sidhartha ; Hofman, David ; Stoker, David L. ; Friend, Peter J. ; Poloniecki, Jan D. ; Thompson, Matt M. ; Holt, Peter J. E.</creator><creatorcontrib>Sinha, Sidhartha ; Hofman, David ; Stoker, David L. ; Friend, Peter J. ; Poloniecki, Jan D. ; Thompson, Matt M. ; Holt, Peter J. E.</creatorcontrib><description>Background
The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome.
Methods
The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay.
Results
A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3 %) cases and increased by 14.6 % over the study period. The in-patient mortality rate (0.2 %), 1 year mortality rate (1 %), proportion of cases converted to open (5.0 %), major BDI rate (0.4 %), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5 %) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.35–1.44) and specialist units (OR 1.32, 95 % CI 1.30–1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95 % CI 1.05–1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes.
Conclusions
The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2415-0</identifier><identifier>PMID: 22806509</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject><![CDATA[Abdominal Surgery ; Age Distribution ; Analysis of Variance ; Bile ducts ; Cholecystectomy ; Cholecystectomy - mortality ; Cholecystectomy - statistics & numerical data ; Cholecystectomy - trends ; Comorbidity ; Conversion to Open Surgery - mortality ; Conversion to Open Surgery - statistics & numerical data ; Disease ; Emergency Treatment - mortality ; Emergency Treatment - statistics & numerical data ; England - epidemiology ; Female ; Gallstones ; Gallstones - mortality ; Gallstones - surgery ; Gastroenterology ; Gynecology ; Health Facility Size - statistics & numerical data ; Hepatology ; Hospitals ; Hospitals, Special - statistics & numerical data ; Humans ; International Classification of Diseases ; Laparoscopy ; Learning curves ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Patients ; Proctology ; Retrospective Studies ; Socioeconomic Factors ; Surgery ; Surgical outcomes ; Treatment Outcome ; Trends]]></subject><ispartof>Surgical endoscopy, 2013, Vol.27 (1), p.162-175</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-5d0a6b7be0ed0f8324ad85f3f8800618f62e9237a7fb1eb2de806e59f77fc3063</citedby><cites>FETCH-LOGICAL-c372t-5d0a6b7be0ed0f8324ad85f3f8800618f62e9237a7fb1eb2de806e59f77fc3063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2415-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2415-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22806509$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sinha, Sidhartha</creatorcontrib><creatorcontrib>Hofman, David</creatorcontrib><creatorcontrib>Stoker, David L.</creatorcontrib><creatorcontrib>Friend, Peter J.</creatorcontrib><creatorcontrib>Poloniecki, Jan D.</creatorcontrib><creatorcontrib>Thompson, Matt M.</creatorcontrib><creatorcontrib>Holt, Peter J. E.</creatorcontrib><title>Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome.
Methods
The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay.
Results
A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3 %) cases and increased by 14.6 % over the study period. The in-patient mortality rate (0.2 %), 1 year mortality rate (1 %), proportion of cases converted to open (5.0 %), major BDI rate (0.4 %), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5 %) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.35–1.44) and specialist units (OR 1.32, 95 % CI 1.30–1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95 % CI 1.05–1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes.
Conclusions
The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.</description><subject>Abdominal Surgery</subject><subject>Age Distribution</subject><subject>Analysis of Variance</subject><subject>Bile ducts</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy - mortality</subject><subject>Cholecystectomy - statistics & numerical data</subject><subject>Cholecystectomy - trends</subject><subject>Comorbidity</subject><subject>Conversion to Open Surgery - mortality</subject><subject>Conversion to Open Surgery - statistics & numerical data</subject><subject>Disease</subject><subject>Emergency Treatment - mortality</subject><subject>Emergency Treatment - statistics & numerical data</subject><subject>England - epidemiology</subject><subject>Female</subject><subject>Gallstones</subject><subject>Gallstones - mortality</subject><subject>Gallstones - surgery</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Health Facility Size - statistics & numerical data</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Hospitals, Special - statistics & numerical data</subject><subject>Humans</subject><subject>International Classification of Diseases</subject><subject>Laparoscopy</subject><subject>Learning curves</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Socioeconomic Factors</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><subject>Trends</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kUGL1TAUhYMoznP0B7iRgBs31ZukbVJ3MjwdYWAWM65Dmtw8M7TNs0kH-hP816a-UUSY1eUm3z2HwyHkNYP3DEB-SAB1W1fAeMVr1lTwhOxYLcrGmXpKdtAJqLjs6jPyIqU7KHjHmufkjHMFbQPdjvzcH4PDMcQhHoI1A015cSuNnh7neB9SiNO22O9xQLumjDbHcaVhovvpMJjJUT_HkfKiTXPcZveRzpjnmI6FDfdIzWSGNYW06VyW55CLTbFN0SG9ySaHlINNL8kzb4aErx7mOfn2eX97cVldXX_5evHpqrJC8lw1Dkzbyx4BHXgleG2carzwSgG0TPmWY8eFNNL3DHvusETFpvNSeiugFefk3Um3BPyxYMp6DMniUMJgXJJmXApZ14I1BX37H3oXl7nE-U2BEEpKVSh2omwJnWb0-jiH0cyrZqC3nvSpJ1160ltPGsrNmwflpR_R_b34U0wB-AlI5Ws64PyP9aOqvwCPxZ4X</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Sinha, Sidhartha</creator><creator>Hofman, David</creator><creator>Stoker, David L.</creator><creator>Friend, Peter J.</creator><creator>Poloniecki, Jan D.</creator><creator>Thompson, Matt M.</creator><creator>Holt, Peter J. E.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>2013</creationdate><title>Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics</title><author>Sinha, Sidhartha ; Hofman, David ; Stoker, David L. ; Friend, Peter J. ; Poloniecki, Jan D. ; Thompson, Matt M. ; Holt, Peter J. E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-5d0a6b7be0ed0f8324ad85f3f8800618f62e9237a7fb1eb2de806e59f77fc3063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Age Distribution</topic><topic>Analysis of Variance</topic><topic>Bile ducts</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy - mortality</topic><topic>Cholecystectomy - statistics & numerical data</topic><topic>Cholecystectomy - trends</topic><topic>Comorbidity</topic><topic>Conversion to Open Surgery - mortality</topic><topic>Conversion to Open Surgery - statistics & numerical data</topic><topic>Disease</topic><topic>Emergency Treatment - mortality</topic><topic>Emergency Treatment - statistics & numerical data</topic><topic>England - epidemiology</topic><topic>Female</topic><topic>Gallstones</topic><topic>Gallstones - mortality</topic><topic>Gallstones - surgery</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Health Facility Size - statistics & numerical data</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Hospitals, Special - statistics & numerical data</topic><topic>Humans</topic><topic>International Classification of Diseases</topic><topic>Laparoscopy</topic><topic>Learning curves</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patients</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Socioeconomic Factors</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Treatment Outcome</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sinha, Sidhartha</creatorcontrib><creatorcontrib>Hofman, David</creatorcontrib><creatorcontrib>Stoker, David L.</creatorcontrib><creatorcontrib>Friend, Peter J.</creatorcontrib><creatorcontrib>Poloniecki, Jan D.</creatorcontrib><creatorcontrib>Thompson, Matt M.</creatorcontrib><creatorcontrib>Holt, Peter J. E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sinha, Sidhartha</au><au>Hofman, David</au><au>Stoker, David L.</au><au>Friend, Peter J.</au><au>Poloniecki, Jan D.</au><au>Thompson, Matt M.</au><au>Holt, Peter J. E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013</date><risdate>2013</risdate><volume>27</volume><issue>1</issue><spage>162</spage><epage>175</epage><pages>162-175</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome.
Methods
The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay.
Results
A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3 %) cases and increased by 14.6 % over the study period. The in-patient mortality rate (0.2 %), 1 year mortality rate (1 %), proportion of cases converted to open (5.0 %), major BDI rate (0.4 %), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5 %) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.35–1.44) and specialist units (OR 1.32, 95 % CI 1.30–1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95 % CI 1.05–1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes.
Conclusions
The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22806509</pmid><doi>10.1007/s00464-012-2415-0</doi><tpages>14</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Age Distribution Analysis of Variance Bile ducts Cholecystectomy Cholecystectomy - mortality Cholecystectomy - statistics & numerical data Cholecystectomy - trends Comorbidity Conversion to Open Surgery - mortality Conversion to Open Surgery - statistics & numerical data Disease Emergency Treatment - mortality Emergency Treatment - statistics & numerical data England - epidemiology Female Gallstones Gallstones - mortality Gallstones - surgery Gastroenterology Gynecology Health Facility Size - statistics & numerical data Hepatology Hospitals Hospitals, Special - statistics & numerical data Humans International Classification of Diseases Laparoscopy Learning curves Length of Stay Male Medicine Medicine & Public Health Middle Aged Mortality Patients Proctology Retrospective Studies Socioeconomic Factors Surgery Surgical outcomes Treatment Outcome Trends |
| title | Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics |
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