Validation of postoperative period of care and textbook outcome as quality measures regarding gallstone surgery.

BACKGROUND

A universally accepted quality measure for gallstone surgery is lacking. In this retrospective study, we evaluated the duration of postoperative care, completion with laparoscopic approach, absence of procedure-related complications, and no readmission as criteria for Textbook Outcome (TO).

METHODS

Data was collected from the Swedish National Register for Gallstone Surgery (GallRiks) 2007-2022. We analyzed postoperative stay as exposure and postoperative complications as outcome using Receiver Operation Characteristic (ROC). TO was defined as laparoscopically completed operations, discharge within three days after surgery, no postoperative complication > Clavien-Dindo 2, no contact with the care provider or new readmission/intervention within 30 days post-surgery. The outcome of TO was further validated based on patients 6 months postoperatively answering SF-36.

RESULTS

A total of 193 201 cholecystectomies were analyzed. Using discharge within three days postoperatively as threshold, the sensitivity was 50 % and the specificity 87 % for predicting a surgery-related complication. The rate of TO in the entire cohort was 79,4 %. Those who met the TO criteria rated notably higher on physical and mental scoring 6 months postoperatively (both p < 0.05) than those who did not.

CONCLUSION

The postoperative period of care and TO are robust outcome measures for evaluating results after gallstone surgery.