Laparoscopic cholecystectomy: quality of care and benchmarking. Results of a single-institution specialized in laparoscopy compared with those of a nationwide study in Switzerland.

摘要

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.