Consumer-driven cholecystectomy: myth or reality?

Abstract

OBJECTIVE: To discover if a consumer-driven process is fueling the high rate of cholecystectomies in the laparoscopic era. DESIGN: A 12-question survey. SETTING: A 1000-bed, university-affiliated hospital. PATIENTS: Patients admitted for elective cholecystectomies. MAIN OUTCOME MEASURES: Survey responses suggesting positive perceptions about laparoscopic cholecystectomy persuade patients to undergo gallbladder surgery. RESULTS: Patients' symptoms persisted for a mean of 20.7 months, range zero to 204. Mean time between diagnosis and surgery was ten months, range 0.1-312. Ninety-five and three-tenths percent knew their gallbladder would be removed; 1.7 percent thought it would be opened to extract stones. Ninety-one and four-tenths percent correctly identified the procedure as "laparoscopic cholecystectomy." Fifty and four-tenths percent believed they would fully recover within a week, 24.1 percent within two weeks, and 14.7 percent within two days. Eighty-three and two-tenths percent knew laparoscopic cholecystectomy required less cutting; 33.6 percent thought a laser was used. Forty-four and eight-tenths percent assumed laparoscopy was the safer method. Sixty-two and one-tenth percent were referred for surgery by family physicians; Seven percent approached surgeons themselves. When asked who first suggested the laparoscopic procedure, 43.1 percent indicated family doctor, 41.4 percent, surgeon, and three percent requested laparoscopy themselves. Twenty-four and one-tenth percent who delayed surgery despite more than 12 months of symptoms indicated escalating pain as their reason for seeking surgery now; 0.9 percent cited the newer procedure. CONCLUSIONS: We found no clear evidence that consumer awareness of laparoscopy has encouraged more cholecystectomies. Misconceptions exist about the procedure's execution and safety. Education about risks, especially bile duct injury, is needed. More frequent referral by family doctors probably plays a role in the higher incidence of cholecystectomies.