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Elderly patients whose bile duct is injured during gallbladder surgery may have a higher death rate, according to a study of 1,570,361 patients who were followed for up to 10 years after the operation. Those whose bile duct was injured during the operation were almost three times more likely to die within the next 10 years. Patients who were oldest and had other diseases were most likely to die.

Surgeons may want to inject a dye into the gallbladder and the bile ducts so they won't injure the bile ducts as they remove the gallbladder, according to a study of 1,570,361 gallbladder operations. The risk of injuring the bile ducts was about 70% higher when this was not done, even after accounting for the surgeon's experience. Injury to the bile ducts is a common cause of medical malpractice claims against surgeons.

The way physicians are compensated for their services appears to have no effect on the use and cost of health services in managed care plans. In some plans, physicians are paid a salary and in others, physicians are paid on the basis of the services they provide. Researchers examined data on health services use and cost for 865 physicians in 60 medical groups covering 200,931 patients. There was no relation between the type of physician compensation and cost and use of health care services., Context. -- Growth of at-risk managed care contracts between health plans and medical groups has been well documented, but less is known about the nature of financial incentives within those medical groups or their effects on health care utilization. Objective. -- To test whether utilization and cost of health services per enrollee were influenced independently by the compensation method of the enrollee's primary care physician. Design. -- Survey of medical groups contracting with selected managed care health plans, linked to 1994 plan enrollment and utilization data for adult enrollees. Setting. -- medical groups, major managed care health plans, and their patents/enrollees in the state of Washington. Study Participants. -- Sixty medical groups in Washington, 865 primary care physicians (internal medicine, pediatrics, family practice, or general practice) from those groups and affiliated with 1 or more of 4 managed care health plans, and 200 931 adult plan enrollees. Intervention.--The effect of method of primary care physician's compensation on the utilization and cost of health services was analyzed by weighted least squares and random effects regression. Main Outcome Measures. -- Total visits, hospital days, and per member per year estimated costs. Results. -- Compensation method was not significantly (P [is greater than .30) related to utilization and cost in any multivariate analyses. Patient age (P [is less than .001), female gender (P [is less than] .001), and plan benefit level (P [is less than] .001) were significantly positively related to visits, hospital days, and per member per year costs. The primary care physician's age was significantly negatively related (P [is less than] .001) to all 3 dependent measures. Conclusions. -- Compensation method was not significantly related to use and cost of health services per person. Enrollee, physician, and health plan benefit factors were the prime determinants of utilization and cost of health services.

Context Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown. Objectives To evaluate the risk of early mortality among Medicare beneficiaries and to determine the relative risk of death among older patients. Design Retrospective cohort study. Setting and Patients All fee-for-service Medicare beneficiaries, 1997-2002. Main Outcome Measures Thirty-day, 90-day, and 1-year postsurgical all-cause mortality among patients undergoing bariatric procedures. Results A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged ≥75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index. Conclusions Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients. [ABSTRACT FROM AUTHOR]