San Diego, CA, May 22, 2016—Over the past 20 years, the number of operations for biliary dyskinesia (BD) has steadily risen, and payment source and income bracket are the two socioeconomic factors that seem to be correlated with laparoscopic cholecystectomy (LC) for BD, according to research presented here at Digestive Disease Week 2016.
“This study was part of a larger analysis that we were doing looking at trends and indications for cholecystectomy over the past 20 years in New York, and seeing if there has been a change in terms of how surgeons are practicing and why people are undergoing this operation over this time frame,” said lead author Vamsi V. Alli, MD, instructor of general surgery, Stony Brook Medicine, Stony Brook, NY.
Dr. Alli and colleagues conducted this study to assess the possibility of any associations between patient factors and the operative indication of BD. They used data from the New York State Planning and Research Cooperative System (NY SPARCS), which is a longitudinal administrative database that includes all inpatient, outpatient, and hospital discharges in New York State, to identify those patients who underwent LC with BD as the operative indication.
In total, they identified 10,662 patients from 1995 to 2014 who underwent LC for BD in the state of New York. They found a steady increase in the incidence of LC for BD, for a 7.57% increase per annum (P < 0.0001). Compared to the population of New York State, a disproportionate number of patients were women (RR: 1.57). The majority of patients presented during their fourth and fifth decade of life (RR: 1.88).
The socioeconomic factors that were positively correlated with BD as the indication for LC included non-governmental payer class (RR: 1.22) and income bracket, and over 60% of operations for BD were done in patients who were in the top 40% earning bracket in the state of New York.
“More telling is the fact that there’s probably a large group of patients who are less advantaged, and that are actually at risk demonstrates potential disparity in our health care system—that patients who have resources and present with symptoms go on to further diagnostic modalities and eventually come up with diagnosis and may undergo the surgery in order to treat it; whereas other patients with nonspecific pain, without signs of infection, without signs of gallstones may go into this category of undiagnosed abdominal pain that may not ever lead to having surgery,” noted Dr. Alli.
“There are factors that put patients at risk for diseases, and then there are studies like ours that look at why we do certain procedures. Those aren’t necessarily the same, and when they aren’t, we need to think about whether we are actually not treating people who need treating,” he concluded.