Cholecystectomies performed by acute care surgeons have higher adverse event rates and longer op.time than those performed by upper GI surgeons

Abstract Introduction In Sweden, there is an ongoing debate between acute care surgeons (ACS) and upper gastrointestinal surgeons including hepato-biliary surgeons (UGIS) regarding which specialists should perform laparoscopic cholecystectomies (LC). This study aims to compare the outcomes between these two surgical groups. Method All laparoscopic cholecystectomies registered in GallRiks between 2020 and 2023 were included. Data on adverse events (AE) and operation times (OT) were analyzed for all procedures, as well as separately for elective and acute cholecystectomies. Result A total of 46,700 procedures were analyzed. Of these, 15,104 (32,3%) operations were performed by UGIS and 3,731 (8.0%) were performed by ACS. Overall, ACS had a higher rate of AE (9.6%) compared to 6.9% for UGIS (OR 1.22; 95% CI 1.07-1.40). The median OT was longer for ACS (105 min) compared to UGIS (72 min) (OR 1.13; 95% CI 1.12-1.15). For acute cholecystectomies, the AE rate was 12% in the ACS group versus 10% in the UGIS group (OR 1.37; 95% CI 1.14-1.64), and the median OT was longer for ACS (119 min) compared to UGIS (95 min) (OR 1.14; 95% CI 1.11-1.16). For elective LC, there were no significant differences in AE (ACS 5.9% versus UGIS 5.8%), but the median OT was longer for ACS (84 min) compared to UGIS (63 min) (OR 1.13 95% OR 1.09-1.17). Discussion LC performed by ACS are associated with a higher rate of adverse events and longer operative times compared to those performed by UGIS. These findings highlight variations in outcomes based on the surgeon's subspecialty.