Increased Cholecystectomy Rate After Introduction of Laparoscopic Cholecystectomy-Reply

Andrew K. Diehl, MD, MSc
JAMA. 1994;271(7):501. doi:10.1001/jama.1994.03510310030018.
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In Reply.  —Foster et al present statistics suggesting that the number of cholecystectomies performed nationally has changed little in recent years. They argue that the abrupt rise in surgical rates reported by Legorreta et al1 in Pennsylvania and discussed in my Editorial2 does not reflect overall US trends. However, published data from the NHDS confirm a recent increase. Total US cholecystectomies rose from 504 000 in 1989 to 571000 in 1991, or 13%. Moreover, in 1991 the age-specific cholecystectomy rates for persons aged 45 to 64 years and 65 years and older were the highest recorded since 1970.3,4 It appears likely that the recent trends documented in Pennsylvania and Connecticut reflect the national scene.1,5The wide variation in per-patient expenditures reported by Drs Klar and Kongstvedt are based on data that may not fully account for differences in clinical presentation. For example, patients suffering acute biliary


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