Increased Cholecystectomy Rate After Introduction of Laparoscopic Cholecystectomy

To the Editor.  —In their article, Legorreta et al¹ suggest that the introduction of laparoscopic cholecystectomy may have caused an increase in the overall consumption of health care resources. They base their conclusion on an apparent increase of almost 60% from 1988 through 1992 in use rates for cholecystectomy from a 500 000-enrollee health maintenance organization (HMO) in southeastern Pennsylvania. While the studied data may be an accurate reflection of one HMO's claims experience, these findings are not supported by an examination of cholecystectomy utilization in three different national data sets.In order to determine whether such an increase in cholecystectomy rates can be generalized to the nation, we analyzed all-payer data from the National Hospital Discharge Survey (NHDS),² Medicare data from the Health Care Financing Administration (HCFA), and hospital discharge data compiled by the HCIA in conjunction with the Commission on Professional and Hospital Activities. Our analysis