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.