Abstract
IMPORTANCE: 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. OBJECTIVE: To evaluate changes in postoperative outcomes and complication rates following minimally invasive cholecystectomy among Medicare beneficiaries between 2011 and 2021. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: 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. RESULTS: Among 516 372 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 (P < .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 (P < .001), and serious complications declined from 12.3% (95% CI, 12.2%-12.5%) to 7.0% (95% CI, 6.9%-7.1%) (P < .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 P < .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%) (P < .001). CONCLUSIONS AND RELEVANCE: 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.