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Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25\u00b70 kg\/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0\u00b752 (95 per cent c.i. 0\u00b745 to 0\u00b757). The predicted probabilities ranged from 0\u00b702 to 0\u00b795 across the 165 hospitals, demonstrating significant variation between hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bjs.10288","type":"journal-article","created":{"date-parts":[[2016,10,17]],"date-time":"2016-10-17T12:37:19Z","timestamp":1476707839000},"page":"1716-1726","source":"Crossref","is-referenced-by-count":39,"title":["Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases"],"prefix":"10.1093","volume":"103","author":[{"name":"CholeS Study Group, West Midlands Research Collaborative","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R 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