The removal of the gallbladder in gallstones is a routine surgical procedure. There are various techniques for performing this operation. The most gentle option for the patient is the laparoscopic approach [Citation1]. In Europe in 2016, between 10.6 and 267.2 people per 100,000 inhabitants and country underwent gallbladder surgery in this way [Citation2].
The 30-day mortality and the number of adverse events, as hard indicators of the quality of care, should always be taken into account in the measurement of cholecystectomy procedure. In an international comparison, there are marginal differences in 30-day mortality. The range of 30-day mortality increases up to 0.49% [Citation3]. Statements on adverse events during cholecystectomy in hospital, 30 days or 90 days after surgery are not available at a national level. As with any other surgical procedure, the follow-up of the patient after discharge is useful to identify subsequent complications or possible retreatments. This serves to determine the overall quality of care in a region. A recent study [Citation4] showed that the duration of surgery alone cannot be used to assess the quality of care in laparoscopic cholecystectomy. Rather, the frequency of the surgeon's intervention is decisive [Citation5] and various risk factors from existing structures and processes must be taken into account in order to evaluate the health care performance. The totality of these criteria should be considered to determine quality indicators for the treatment of gallbladder problems and thus to evaluate the quality of care.
The present study [Citation4] showed also a significant difference in operative time between two surgical departments in Sweden and the chosen dissecting techniques of laparoscopic cholecystectomy, but no difference in the operative outcome. Register data were used to generate these findings. The register data contains comprehensive data of inpatient and outpatient care. This enables a holistic view of country’s health care system and its participants. Whether the results can also be generalized to other clinics should be the subject of further research activities. The use and evaluation of existing data sets should also be sought in other countries to assess the quality of health care.
In Germany, it was decided in 2016 to suspend nationwide quality assurance in the field of cholecystectomy in accordance with §137 SGB V (Social Code Book V) and to carry it out exclusively on a voluntary basis from 2017. Since the nationwide quality assurance in Germany is based on manual documentation and thus additional effort, this form of voluntary implementation is only pursued to a limited extent. This entails dangers in monitoring and thus the knowledge of the actual care situation for patients with gallbladder problems. In addition to statutory quality assurance, there are initiatives that allow a low-cost and efficient procedure for valid determination of the quality of care [Citation6]. These initiatives work on the basis of already collected data and have the same significance. The legislator in Germany follows this approach and will also implement routine data-supported quality assurance procedures from 2019. This also includes laparoscopic cholecystectomies. Routine data often include billing data from service providers, as these are collected comprehensively and regularly and checked by various bodies with regard to their content. In addition to billing data, there are other routine data sources that can be used to describe health care. Register data can also be used to determine the quality of care, as in a recent study [Citation4]. Register data is a valid and reliable data source that is available for clinical research, health care research and also health care analyses.
The handling of information on the quality of care of surgical treatments – also for the routine intervention of cholecystectomy – represents an essential element for a modern health system in order to analyze the health status of the population and the effectiveness of care structures and processes. Clinical studies and health care research studies for the continuous review of established knowledge against the background of the further development of health care combined with innovative approaches, such as the use of new data sources, are of high relevance for a future-oriented health care system.
Declaration of interest
The author reports no conflict of interest. The author alone is responsible for the content and writing of the article.
References
- Zacks SL, Sandler RS, Rutledge R, Brown RS. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002;97(2):334–340. Feb
- Eurostat-Statistics Explained. Surgical operations and procedures performed in hospitals-top 10 procedures 2016. Data based on November 19, 2018.
- Harrison EM, O'Neill S, Meurs TS, et al. Hospital volume and patient outcomes after cholecystectomy in Scotland: retrospective, national population based study. BMJ 2012;344(may23 1):e3330. doi:10.1136/bmj.e3330.
- Odelberg N, Cengiz Y, Jänes A, Hennings J. The impact of a surgical unit's structure and operative technique on quality in two Swedish rural hospitals. J Invest Surg. In press
- Wenning M, Hupe K, Scheuer I, Senninger N, Smektala R, Windhorst T. Does quantity mean quality? An analysis of 116,000 patients regarding the connection between the number of cases and the quality of results. Chirurg 2000; 71(6):717–722.
- Mansky T, Nimptsch U, Cools A, Hellerhoff F. (2017). G-IQI | German Inpatient Quality Indicators. Version 5.1. - Band 2: Definitionshandbuch für das Datenjahr 2017. Berlin (Germany): Universitätsverlag der TU Berlin