Nationwide quality improvement of cholecystectomy: results from a national database.

OBJECTIVE: To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones. DESIGN: A national database that monitors the quality of cholecystectomy was established, and registration of all cholecystectomies in Denmark was mandatory since 1 January 2006. Indicators describing the operation, the postoperative course, the surgical outcome and various risk factors were followed for 4 years. RESULTS: from 2006 were defined as reference values and indicator values, and covariates were stratified by year and tested for trend. Logistic regression models were used to adjust for changes in the prevalence of risk factors/covariates in the study period. SETTING: Nationwide, prospective clinical database in Denmark. Data from 2006 to 2009. PARTICIPANTS: 23,672 patients undergoing cholecystectomy where a laparoscopic procedure was considered the standard operation according to national guidelines. MAIN OUTCOME MEASURES: The rate of conversion from laparoscopic to open operation, the frequency of primary open operations where laparoscopic procedure was the standard, length of postoperative stay including frequency of same-day surgery, additional surgical procedures within 30 days, readmission and mortality. Results Conversion rate and frequency of primary open cholecystectomy were reduced in the study period. Same-day surgery increased by 14.6%, without an increase in readmission rate (9.4%). The frequency of 'additional procedures within 30 days' was also reduced (2.8%). The frequency of injuries requiring reconstructive bile-duct surgery was unaffected (0.15%). CONCLUSION: The study demonstrates nationwide quality improvements of cholecystectomy in Denmark from 2006 to 2009.

Sex differences in laparoscopic cholecystectomy.

BACKGROUND: Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients. METHODS: The gender of 5,951 patients from the 2007 National Danish Cholecystectomy Database was compared with conversion rate, length of hospital stay, and various risk factors using multivariate analyses. RESULTS: The findings showed that 14.3% of the patients had acute cholecystitis and that men had the highest risk (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.66-2.27). The operative findings for the men included sequelae from previous acute cholecystitis more frequently than the findings for the women (OR, 1.89; 95% CI, 1.67-2.15). The rate for conversion from laparoscopic to open surgery was 7.7%, and male sex was highly associated with conversion (OR, 2.48; 95% CI, 2.04-3.01). Thus, 259 (5.8%) of the 4,451 operations for women were converted to laparotomy compared with 199 (13.3%) of the 1,500 operations for men. No significant sex differences were found in the proportion of bile duct lesions (those requiring reconstructive surgery as well as those that could be handled by endoscopy or T-tube drainage, suturing, or both) or in the 30-day mortality rate. The multivariate analyses showed that male sex was a significant factor for conversion but not for length of postoperative stay or readmission. CONCLUSION: Men showed a significantly higher risk of the operation being converted from laparoscopic to open cholecystectomy than women (OR, 2.48; 95% CI, 2.04-3.01). The main reason for this may be that men more frequently had acute cholecystitis or sequelae from previous acute cholecystitis. These results can be used to give patients a better basis for their informed consent and better resource management in connection with the operation.