Laparoscopic cholecystectomy: quality of care and benchmarking. Results of a single-institution specialized in laparoscopy compared with those of a nationwide study in Switzerland.
BACKGROUND
Quality control is an important issue in surgery. Therefore, we assessed the outcome of laparoscopic cholecystectomies (LC) performed at our institution specialized in laparoscopic surgery in order to do a benchmarking.


METHODS
The perioperative courses of the first 1000 LCs performed in Aarberg hospital were recorded, analyzed, and compared with the results of a recent study including 10, 174 patients published by the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS).


RESULTS
The following quality indicators were compared with the corresponding SALTS rates: primary conversion rate 1.5% (SALTS 8.2%; p <0.01); conversion rate for intraoperative complications 6.5% (63.8%; p <0.01); intraoperative complication rate 22.2% (34.4%; p <0.01); postoperative morbidity rate 8.1% (10.4%; n.s.); in-hospital mortality rate 0.1% (0.2%; n.s.); and reoperation rate 0.8% (1.7%; n.s.).


CONCLUSIONS
LC has reached a high quality level in its widespread use, but in a small specialized center even a higher quality level can be achieved. Favorable results seem to depend on structural advantages of a surveyable unit in association with a continuously motivated surgical team.
Müller
B P
BP
Department of Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
Holzinger
F
F
Leepin
H
H
Klaiber
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000401:mortality / Q000592:standards*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology