February 9, 1994
Media Contact:Joann Rodgers
Phone: (410) 223-1731

A Johns Hopkins study has found that after the introduction of a new surgical technique, more Marylanders elected to undergo surgery to relieve gallbladder pain. Surgery rates increased by 28 percent overall says the study, and the use of the new, less invasive, laparoscopic procedure skyrocketed, especially among those in health maintenance organizations (HMOs).

The study is the first in Maryland to analyze the pattern of a procedure called laparoscopic cholecystectomy, or 'lap chole'. According to the researchers, the procedure met unprecedented acceptance shortly after its introduction in 1989, without having undergone the scrutiny of a prospective randomized clinical trial.

"As a result, there were many concerns about safety, who got the procedure and when," says Claudia Steiner, M.D., M.P.H., lead author of the study, which appears in the February 10 issue of the New England Journal of Medicine.

By 1992, 76 percent of all gallbladder removals in Maryland were performed laparoscopic. Meanwhile, traditional open surgery for gallbladder removal decreased by 70 percent over the same period, says the study.

Surgical death rates plummeted as well declining 33 percent from 1989 to 1992, the period when lap chole use was on the rise. Because of the increase in the number of choles being performed, however, the total number of operative deaths related to chole remained constant, says Steiner.

"Historically, surgeons wait for the results of intense testing to use a new procedure such as this," says Mark Talamini,, MD., a general surgeon and co-author of the study. "But there were many patients putting up with pain for years in order to avoid surgery. Lap choles were thought to be safe, less painful less disfiguring and associated with less hospitafintion and quicker recovery time. So surgeons signed on at the prompting of their patients."

Lap chole rates continued to climb through 1991, but by 1992, reached a plateau in Maryland a finding never identified before. "We suspect that with lap chole there was a change in the mindset of patients and surgeons, both more to consider this less invasive procedure," says Earl Steinberg, M.D., M.P.P., a co-author of the study,

The study also offers unexpected insight into the practices of Maryland insurance providers, says Steinberg.

"Interestingly, patients with HMO medical insurance are more likely to receive this new procedure study showed that HMO users received the same, than people with indemnity insurance," he said. if not better access to this new technology."

Steinberg directs the Johns Hopkins Program for Medical Technology and Practice Assessment. He and others evaluate medical procedures, devices and drugs, measuring results, quality of care, patient and tubular instrument passed through a small satisfaction and cost-effectiveness.

Laparoscopic cholecystectomy uses anincision, usually in the bellybutton. With additional tools, the surgeons can detach the gallbladder, and remove it through the incision to relieve chronic pain caused by recurrent bacterial infections and gallstones. According to Talaminil, studies suggest that some complication are associated with lap chole, including an increased risk of injury to the common bile duct, from roughly one in 1,000 cases to one in 500 cases.

Other authors on the study include Eric B. Bass, M.D., M.P.H., assistant professor of medicine with a joint appointment in health policy and management at the Johns Hopkins School of Public Health, and Henry A. Pitt, M.D., professor of surgery.

-- JHMI --
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