{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:21:05Z","timestamp":1791598865402,"version":"4.3.4"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-soi250104-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Cholecystectomy is among the most common surgical procedures in the US, yet as patient complexity has increased and surgical techniques have evolved, contemporary trends in complication rates remain understudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi250104-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate changes in postoperative outcomes and complication rates following minimally invasive cholecystectomy among Medicare beneficiaries between 2011 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi250104-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cohort study used Medicare fee-for-service claims data from 2011 to 2021 to identify beneficiaries undergoing inpatient minimally invasive (laparoscopic or robotic) cholecystectomy. Risk-adjusted outcomes were estimated using multivariable logistic regression with marginal effects, adjusting for demographics, comorbidities, biliary diagnosis, admission type, and year. Adjusted estimates for length of stay were estimated using multivariable Poisson regression with marginal effects, adjusting for the same covariates. Data were analyzed between March and August 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi250104-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Key outcomes included length of stay, 30-day readmission, complications, serious complications, 30-day mortality, and in-hospital mortality. Specific complications, such as intraoperative hemorrhage, bile duct injury, transfusion, percutaneous drainage, urinary tract infection, and deep venous thrombosis, were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi250104-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 516\u202f372 Medicare fee-for-service beneficiaries (mean [SD] age, 74.8 [9.8] years; 52.4% female), the proportion who had unplanned (vs elective) admissions for cholecystectomy increased from 78.8% in 2011 to 90.1% in 2021 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), alongside increases in Elixhauser comorbidity burden. Risk-adjusted rates of overall complications decreased from 21.5% (95% CI, 21.3%-21.7%) in 2011 to 16.5% (95% CI, 16.4%-16.7%) in 2021 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), and serious complications declined from 12.3% (95% CI, 12.2%-12.5%) to 7.0% (95% CI, 6.9%-7.1%) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). Specific complications also improved, including intraoperative hemorrhage (1.07% [95% CI, 1.01%-1.13%] to 0.54% [95% CI, 0.50%-0.58%]), blood transfusion (5.47% [95% CI, 5.34%-5.60%] to 1.87% [95% CI, 1.80%-1.94%]), and bile duct injury (0.19% [95% CI, 0.16%-0.21%] to 0.12% [95% CI, 0.11%-0.14%]) (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). However, rates of postoperative percutaneous drainage increased from 1.32% (95% CI, 1.26%-1.37%) to 2.91% (95% CI, 2.81%-3.01%) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi250104-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study of Medicare beneficiaries undergoing inpatient minimally invasive cholecystectomy, surgical complication rates, including bile duct injury, declined substantially from 2011 to 2021 despite increasing patient complexity. These improvements may reflect improved technique, overcoming the initial learning curve, or the cumulative influence of quality improvement efforts. The increasing use of drainage may reflect evolving surgical practice rather than declining quality, which underscores the need for continued investigation and surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.6865","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T16:30:48Z","timestamp":1772037048000},"page":"398","source":"Crossref","is-referenced-by-count":5,"title":["Contemporary Outcomes of Cholecystectomy"],"prefix":"10.1001","volume":"161","author":[{"given":"Cody Lendon","family":"Mullens","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"},{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"},{"name":"UM National Clinician Scholars Program, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua K.","family":"Sinamo","sequence":"additional","affiliation":[{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hallway","sequence":"additional","affiliation":[{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"},{"name":"University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle H.","family":"Sheetz","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"},{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne P.","family":"Ehlers","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"},{"name":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana 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