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International Journal for Quality in Health Care Advance Access published online on January 24, 2008
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzm073
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© The Author 2008. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Outcome measurement in laparoscopic cholecystectomy by using a prospective complication registry: results of an audit

Eelco J Veen1, Marianne Bik1, Maryska L.G. Janssen-Heijnen2, Maryska De Jongh1 and Anne J. Roukema1

1 Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands
2 Comprehensive Cancer Centre South, Eindhoven, The Netherlands

Objective. The aim was to assess and discuss the utility of a complication registry for determining outcome and delivered care in surgery.

Method. 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.

Conclusion. 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.

Keywords: complication registry, quality of care, outcome measurement, laparoscopic cholecystectomy

Address reprint requests to: Eelco J Veen, MD, Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands. Tel: +31 135 39 29 25; Fax: +31 135 36 36 60. E-mail: eelco.veen{at}wanadoo.nl, eveen{at}jbz.nl

Accepted for publication December 9, 2007.


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