Outcome measurement in laparoscopic cholecystectomy by using a prospective complication registry: results of an audit.
OBJECTIVE
The aim was to assess and discuss the utility of a complication registry for determining outcome and delivered care in surgery.


METHODS
All patients with Laparoscopic Cholecystectomy between 1998 and 2006 were analysed. Complications were prospectively documented and evaluated according to outcome measures mentioned in literature (bile duct injury, morbidity, mortality and conversion rate) for Laparoscopic Cholecystectomy. In addition, all patient files were evaluated for possible risk factors and non-registered complications.


RESULTS
One thousand two hundred fifty four Laparoscopic Cholecystectomies were performed, with 207 complications in 152 (12%) patients. Eighteen (9%) events were additionally found after evaluating all medical files. Thirteen (1%) bile duct injuries occurred, 7% (n = 91) morbidity, no mortality and 18% (n = 226) conversion rate. The probability of complications was significantly higher in patients diagnosed with complicated gallstone disease, ASA 3/4, > 70 years, acute and converted procedures. Thirty % (n = 63) of all documented adverse events reflected issues other than traditionally mentioned outcome measures, categorised as hospital-provider errors or miscellaneous.


CONCLUSIONS
Ninety % of all complications in laparoscopic cholecystectomy were documented in our registry. Factors associated with a high probability of complications were identified and 30% of all events reflected issues other than traditionally mentioned outcome measures for Laparoscopic Cholecystectomy. The registry can be used for outcome measurement, however differences in case mix and data collection methods should be taken into account.
Veen
Eelco J
EJ
Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands. eelco.veen@wanadoo.nl
Bik
Marianne
M
Janssen-Heijnen
Maryska L G
ML
De Jongh
Maryska
M
Roukema
Anne J
AJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care; D012042:Registries / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D016896:Treatment Outcome