Cholecystectomies performed in children by pediatric surgeons compared to general surgeons in North Carolina are associated with higher institutional charges

Introduction: The delivery of pediatric surgical care for gallbladder (GB) and biliary disease involves both General Surgeons (GS) and Pediatric Surgeons (PS). There is a lack of data describing how surgeon specialty impacts practice patterns and healthcare charges. Methods: We performed a retrospective review of the North Carolina Inpatient Hospital Discharge Database (2013-2017) on pediatric patients (<= 18 years) undergoing surgery for biliary pathology. We performed multivariate linear regression comparing surgeons with surgical charge. Results: 12,531 patients had GB or biliary pathology and 4023 (32.1%) had cholecystectomies. The most common procedure for PS and GS was cholecystectomy for cholecystitis (n = 509, 54.0% and n = 2275, 76.4%, p < 0.001), respectively. The hospital ($26,605, IQR $18,955-37,249, vs. $17,451, IQR $13,246-23,478, p < 0.001) and surgical charges ($15,465, IQR $12,233-22,203, vs. $10,338, IQR $6837-14,952, p < 0.001) were higher for PS than GS. Controlling for pertinent variables, surgical charges for PS were $4192 higher than for GS (95% CI: $2162-6122). Conclusion: The cholecystectomy charge differential between PS and GS is significant and persisted after controlling for pertinent covariates.