National Trends in Percutaneous Cholecystostomy Between 1994 and 2009: Perspectives From Medicare Provider Claims

Purpose: The aim of this study was to assess national trends and regional variation in the utilization of percutaneous cholecystostomy (PC). Methods: Medicare fee-for-service claims files from 1994 to 2009 were used to identify trends in PC compared with laparoscopic and open surgical gallbladder procedures. Volume, geographic variation, provider specialty, and service site were analyzed. Results: Between 1994 and 2009, annual PC procedures increased by 567% (from 1,085 to 7,239). Laparoscopic cholecystectomy increased by 3% (from 203,836 to 209,650), and open procedures declined by 73% (from 119,086 to 32,222). As a percentage of all gallbladder procedures, PC increased from 0.3% to 2.9% and varied considerably among Medicare regions, ranging from 1.4% (Denver) to 5.2% (Boston). Radiologists perform most PC procedures (97%), and most are performed on hospital inpatients (92%). Conclusions: Annual PC procedures on Medicare beneficiaries increased almost 6-fold in recent years, as laparoscopic cholecystectomy remained stable, and open procedures declined. The relative utilization of PC varies considerably by region across the United States.