Appropriateness variation in cholecystectomy.
BACKGROUND
Cholecystectomy use varies moderately across regions and countries. The purpose of this study was to evaluate the appropriateness of the use of cholecystectomy in patients with nonmalignant diseases in different hospitals using explicit criteria developed by an expert panel.


METHODS
Patients on waiting lists to undergo a cholecystectomy for nonmalignant diseases in six public hospitals in Spain were included in this prospective observational study over a 1-year period. Appropriateness criteria were first developed by a panel of experts using the RAND appropriateness method. The appropriateness of the indication was judged by applying explicit criteria developed previously. Complications were recorded 3 months after surgery.


RESULTS
After evaluation of 960 patients, 7 (0.7%) were considered to have undergone inappropriate procedures and 76 (7.9%) were judged to be uncertain. Differences were found in the rate of appropriateness among some centres (inappropriateness rate ranging from to 0 to 2.6%). No differences were found among the appropriateness categories for length of stay or complications, mortality, or readmission up to the third month after discharge.


CONCLUSIONS
This study identified a low percentage of inappropriately performed cholecystectomies in our area. Even so, appropriateness differences among hospitals were found.
Quintana
José M
JM
Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain. jmquinta@hgda.osakidetza.net
Cabriada
José
J
López de Tejada
Ignacio
I
Perdigo
Luis
L
Aróstegui
Inmaculada
I
Bilbao
Amaia
A
Garay
Idoia
I
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D048909:Diabetes Complications; D005260:Female; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D014600:Utilization Review