Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):339-346. 10.14701/ahbps.22-007.

Gallbladder-associated hospital admission and cholecystectomy rates across Australia and Aotearoa New Zealand (2004–2019): Are we over-intervening?

• Mollah T
• Christie H
• Chia M
• Modak P
• Joshi K
• Soni T
• Qin KR

• KMID: 2536384
• DOI: http://doi.org/10.14701/ahbps.22-007

Abstract

Backgrounds/Aims
To investigate if the increase in the number of cholecystectomies is proportional to symptomatic gallbladder-associated hospital admissions in Australia and Aotearoa New Zealand (NZ).
Methods
National healthcare registries were used to obtain data on all episodes of cholecystectomies and hospital admissions for patients ≥ 15 years from public and private hospitals.
Results
Between 2004 and 2019, in Australia, there have been 1,074,747 hospital admissions and 779,917 cholecystectomies, 715,462 (91.7%) of which were laparoscopic, and 163,084 admissions and 98,294 cholecystectomies in NZ. The 15–54 years age group saw an increase in operative rates, +4.0% in Australia and +6.6% in NZ, and admissions, +3.7% and +5.8%, respectively. Hospital admissions decreased by –9.8% in Australia but the proportion of patients undergoing intervention increased by 10.8% (from 67.1% to 75.0% of hospital admissions). Procedural rates increased by +7.3% in NZ with no change in the intervention rate.
Conclusions
In Australia, there has been a decline in symptomatic gallbladder-associated hospital admissions and a rise in intervention rate. Admissions and interventions have increased proportionally in NZ. There are higher rates of cholecystectomy and admission amongst younger demographics, compared to historical cohorts. Future research should focus on identifying risk factors for increased disease and operative rates amongst younger populations.

Keyword

Gallbladder; Cholelithiasis; Cholecystectomy; Australia; New Zealand

Figure

• 

  Fig. 1 Hospital admissions due to gallbladder-associated disease in Australia and New Zealand per 100,000 age-standardized population ≥ 15 years old. (A) Combined gallbladder-associated admissions (ICD-10 Code K80 + K81 + K82), (B) cholelithiasis (ICD-10 Code K80), (C) cholecystitis (ICD-10 Code K81), and (D) other diseases of the gallbladder (ICD-10 Code K82) including New Zealand public and private sector data.

• 

  Fig. 2 The proportion of female patients being admitted or undergoing surgery in Australia and New Zealand. (A) Percentage of hospital admissions due to cholelithiasis (ICD-10 Code K80) or cholecystitis (ICD-10 Code K81) for female patients, and (B) percentage of cholecystectomies for female patients.

• 

  Fig. 3 All public and private inpatient cholecystectomy procedures per 100,000 age-standardised population ≥ 15 years old. (A) Combined procedure rates in Australia and New Zealand, (B) proportion of admitted patients undergoing intervention, i.e., “intervention rate” for ICD-10 Code K80, K81, and Australian cholecystectomy rates by laparoscopic (C) and open procedures (D).

• 

  Fig. 4 Age demographics of patients per 100,000 age-standardized population ≥ 15 years old amongst two cohorts (2004–2005 and 2018–2019). (A) Admitted to hospital with gallbladder-associated disease (ICD-10 Code K80–82) and (B) undergoing cholecystectomy.

Reference

1. Stinton LM, Shaffer EA. 2012; Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 6:172–187. DOI: 10.5009/gnl.2012.6.2.172. PMID: 22570746. PMCID: PMC3343155.

2. 2021. Disease expenditure in Australia 2018-19 [Internet]. Canberra: Australian Institute of Health and Welfare;Available from: https://www.aihw.gov.au/reports/health-welfare-expenditure/disease-expenditure-australia/data-1. cited 2022 Mar 11.

3. Rob MI, Corben P, Rushworth RL. 1998; The impact of new technology on cholecystectomy rates in New South Wales. J Qual Clin Pract. 18:263–274. DOI: 10.1046/j.1440-1762.1998.00282.x. PMID: 9862663.

4. Hobbs MS, Mai Q, Fletcher DR, Ridout SC, Knuiman MW. 2004; Impact of laparoscopic cholecystectomy on hospital utilization. ANZ J Surg. 74:222–228. DOI: 10.1111/j.1445-2197.2004.02955.x. PMID: 15043732.

5. Marshall D, Clark E, Hailey D. 1994; The impact of laparoscopic cholecystectomy in Canada and Australia. Health Policy. 26:221–230. DOI: 10.1016/0168-8510(94)90041-8. PMID: 10133133.

6. Bailey RW, Imbembo AL, Zucker KA. 1991; Establishment of a laparoscopic cholecystectomy training program. Am Surg. 57:231–236.

7. Windsor JA, Vokes DE. 1994; Early experience with minimally invasive surgery: a New Zealand audit. Aust N Z J Surg. 64:81–87. DOI: 10.1111/j.1445-2197.1994.tb02148.x. PMID: 8291983.

8. Pedersen G, Hoem D, Andrén-Sandberg A. 2002; Influence of laparoscopic cholecystectomy on the prevalence of operations for gallstones in Norway. Eur J Surg. 168:464–469. DOI: 10.1080/110241502321116460. PMID: 12549686.

9. Urbach DR, Stukel TA. 2005; Rate of elective cholecystectomy and the incidence of severe gallstone disease. CMAJ. 172:1015–1019. DOI: 10.1503/cmaj.1041363. PMID: 15824406. PMCID: PMC556039.

10. Escarce JJ, Chen W, Schwartz JS. 1995; Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy. JAMA. 273:1581–1585. DOI: 10.1001/jama.1995.03520440035033. PMID: 7745770.

11. Lam CM, Murray FE, Cuschieri A. 1996; Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy in Scotland. Gut. 38:282–284. DOI: 10.1136/gut.38.2.282. PMID: 8801212. PMCID: PMC1383038.

12. Australian Bureau of Statistics. 2001. Population characteristics: populations of Australia and New Zealand: a comparison [Internet]. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/2f762f95845417aeca25706c00834efa/e29b7c0ef9e294dcca2570ec000bf8f4!OpenDocument. cited 2021 Nov 29. Canberra: Australian Bureau of Statistics.

13. Mossialos E, Djordjevic A, Osborn R, Sarnak D. 2017. International profiles of Health Care Systems [Internet]. Available from: https://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles-health-care-systems. cited 2021 Nov 29. New York: The Commonwealth Fund.

14. Australian Institute of Health and Welfare. 2021. Our data collections [Internet]. Available from: https://www.aihw.gov.au/about-our-data/our-data-collections. cited 2021 Nov 10. Canberra: Australian Institute of Health and Welfare.

15. Ministry of Health NZ. 2021. Hospital event data and stats [Internet]. Available from: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/hospital-event-data-and-stats. cited 2021 Nov 10. Wellington: Ministry of Health NZ.

16. Australian Bureau of Statistics. 2021. Population [Internet]. Available from: https://www.abs.gov.au/statistics/people/population. cited 2021 Nov 27. Canberra: Australian Bureau of Statistics.

17. Stats NZ. 2020. Population [Internet]. Available from: https://www.stats.govt.nz/topics/population. cited 2021 Nov 27. Wellington: New Zealand Government.

18. Government of Canada, Statistics Canada. 2017. Age-standardized Rates [Internet]. Available from: https://www.statcan.gc.ca/en/dai/btd/asr. cited 2021 Nov 10. Ottawa: Statistics Canada.

19. Kim HJ, Fay MP, Feuer EJ, Midthune DN. 2000; Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 19:335–351. Erratum in: Stat Med 2001;20:655.DOI: 10.1002/sim.811.

20. Fleming WR, Michell I, Douglas M. 2000; Audit of outpatient laparoscopic cholecystectomy. Universities of Melbourne HPB Group. Aust N Z J Surg. 70:423–427. DOI: 10.1046/j.1440-1622.2000.01840.x. PMID: 10843397.

21. Friedlander DF, Krimphove MJ, Cole AP, Marchese M, Lipsitz SR, Weissman JS, et al. 2021; Where is the value in ambulatory versus inpatient surgery? Ann Surg. 273:909–916. DOI: 10.1097/SLA.0000000000003578. PMID: 31460878.

22. Sherigar JM, Irwin GW, Rathore MA, Khan A, Pillow K, Brown MG. 2006; Ambulatory laparoscopic cholecystectomy outcomes. JSLS. 10:473–478.

23. Bellows CF, Berger DH, Crass RA. 2005; Management of gallstones. Am Fam Physician. 72:637–642.

24. Chilimuri S, Gaduputi V, Tariq H, Nayudu S, Vakde T, Glandt M, et al. 2017; Symptomatic gallstones in the young: changing trends of the gallstone disease-related hospitalization in the State of New York: 1996 - 2010. J Clin Med Res. 9:117–123. DOI: 10.14740/jocmr2847w. PMID: 28090227. PMCID: PMC5215015.

25. Australian Institute of Health and Welfare. 2021. Overweight and obesity [Internet]. Available from: https://www.aihw.gov.au/reports/australias-health/overweight-and-obesity. cited 2021 Dec 9. Canberra: Australian Institute of Health and Welfare.

26. Ministry of Health NZ. 2016. Annual update of key results 2016/17: New Zealand Health Survey [Internet]. Available from: https://www.health.govt.nz/publication/annual-update-key-results-2016-17-new-zealand-health-survey. cited 2021 Dec 9. Wellington: Ministry of Health NZ.

27. Cancer Council Victoria. 2021. Obesity trends in Australian adults [Internet]. Available from: https://www.obesityevidencehub.org.au/collections/trends/adults-australia. cited 2021 Jul 19. Victoria: Cancer Council.

28. Ministry of Health NZ. 2021. Obesity statistics [Internet]. Available from: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics. cited 2022 Mar 4. Wellington: Ministry of Health NZ.

29. Bonfrate L, Wang DQ, Garruti G, Portincasa P. 2014; Obesity and the risk and prognosis of gallstone disease and pancreatitis. Best Pract Res Clin Gastroenterol. 28:623–635. DOI: 10.1016/j.bpg.2014.07.013. PMID: 25194180.

30. Su PY, Hsu YC, Cheng YF, Kor CT, Su WW. 2019; Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50 years. BMC Gastroenterol. 19:117. DOI: 10.1186/s12876-019-1032-y. PMID: 31272395. PMCID: PMC6610843.

31. Australian Institute of Health and Welfare. 2021. Diabetes [Internet]. Available from: https://www.aihw.gov.au/reports/australias-health/diabetes. cited 2022 Mar 4. Canberra: Australian Institute of Health and Welfare.

32. Best Practice Advocacy Centre NZ. 2021. A rising tide of type 2 diabetes in younger people: what can primary care do? [Internet]. Available from: https://bpac.org.nz/2021/diabetes-younger.aspx#fig2. cited 2022 Mar 4. Dunedin: The bpacnz Team.

33. Mollah T, Chia M, Wang LC, Modak P, Qin KR. Epidemiological trends of gallbladder cancer in Australia between 1982 to 2018: a population-based study utilizing the Australian Cancer Database. Ann Hepatobiliary Pancreat Surg. 2022; https://doi.org/10.14701/ahbps.21-169. [in press]. DOI: 10.14701/ahbps.21-169. PMID: 35193994. PMCID: PMC9428426.

34. Anderson I, Crengle S, Kamaka ML, Chen TH, Palafox N, Jackson-Pulver L. 2006; Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 367:1775–1785. DOI: 10.1016/S0140-6736(06)68773-4. PMID: 16731273.

35. Campbell S, Richardson B, Mishra P, Wong M, Samarakkody U, Beasley S, et al. 2016; Childhood cholecystectomy in New Zealand: a multicenter national 10year perspective. J Pediatr Surg. 51:264–267. DOI: 10.1016/j.jpedsurg.2015.10.071. PMID: 26831530.

36. O'Brien P, Bunzli S, Lin I, Bessarab D, Coffin J, Dowsey MM, et al. 2021; Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action. ANZ J Surg. 91:238–244. DOI: 10.1111/ans.16557. PMID: 33506978.

37. Rahiri JL, Alexander Z, Harwood M, Koea J, Hill AG. 2018; Systematic review of disparities in surgical care for Māori in New Zealand. ANZ J Surg. 88:683–689. DOI: 10.1111/ans.14310. PMID: 29150888.

38. Wang HH, Liu M, Clegg DJ, Portincasa P, Wang DQ. 2009; New insights into the molecular mechanisms underlying effects of estrogen on cholesterol gallstone formation. Biochim Biophys Acta. 1791:1037–1047. DOI: 10.1016/j.bbalip.2009.06.006. PMID: 19589396. PMCID: PMC2756670.

39. Australian Bureau of Statistics. 2018. High cholesterol [Internet]. Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/high-cholesterol/latest-release. cited 2021 Dec 9. Canberra: Australian Bureau of Statistic.

40. Gentles D, Metcalf P, Dyall L, Scragg R, Sundborn G, Schaaf D, et al. 2007; Serum lipid levels for a multicultural population in Auckland, New Zealand: results from the Diabetes Heart and Health Survey (DHAH) 2002-2003. N Z Med J. 120:U2800.

41. Kurtin WE, Schwesinger WH, Diehl AK. 2000; Age-related changes in the chemical composition of gallstones. Int J Surg Investig. 2:299–307.

42. Dixit SK, Sambasivan M. 2018; A review of the Australian healthcare system: a policy perspective. SAGE Open Med. 6:2050312118769211. DOI: 10.1177/2050312118769211. PMID: 29686869. PMCID: PMC5900819.

43. Mui J, Mayne DJ, Davis KJ, Cuenca J, Craig SJ. 2021; Increasing use of intraoperative cholangiogram in Australia: is it evidence-based? ANZ J Surg. 91:1534–1541. DOI: 10.1111/ans.16912. PMID: 33982363.

44. Ballal M, David G, Willmott S, Corless DJ, Deakin M, Slavin JP. 2009; Conversion after laparoscopic cholecystectomy in England. Surg Endosc. 23:2338–2344. DOI: 10.1007/s00464-009-0338-1. PMID: 19266237.