Abstract
Despite an increasing emphasis on data-driven quality improvement, few validated quality indicators for emergency surgical services have been published. The aims of this study therefore were: 1) to investigate whether the acute cholecystectomy rate is a valid process indicator; and 2) to use this rate to examine variation in the provision of acute cholecystectomy in England. The Surgical Workload and Outcomes Research Database (SWORD), derived from the Hospital Episode Statistics database, was interrogated for the 2012-2017 financial years. All adult patients admitted with acute biliary pancreatitis, cholecystitis or biliary colic to hospitals in England were included and the acute cholecystectomy rate in each one examined. A total of 328,789 patients were included, of whom 42,642 (12.9%) underwent an acute cholecystectomy. The acute cholecystectomy rate varied significantly between hospitals, with the overall rate ranging from 1.2% to 36.5%. This variation was consistent across all disease groupings and time periods, and was independent of the annual number of procedures performed by each NHS trust. In 41 (29.9%) trusts, fewer than one in ten patients with acute gallbladder disease underwent cholecystectomy within two weeks. The acute cholecystectomy rate is easily measurable using routine administrative datasets, modifiable by local services and has a strong evidence base linking it to patient outcomes. We therefore advocate that it is an ideal process indicator that should be used in quality monitoring and improvement. Using it, we identified significant variation in the quality of care for acute biliary disease in England.
Highlights
Despite an increasing emphasis on data-driven quality improvement, few validated quality indicators for emergency surgical services have been published
Acute biliary disease comprises a significant proportion of the general emergency surgical workload, with approximately 60,000 patients admitted to English NHS hospitals each year.[1]
Previous meta-analyses have shown that early cholecystectomy improves outcomes for patients with acute biliary disease, resulting in a reduced total length of stay, faster recovery, reduced morbidity and reduced healthcare costs with no increased risk of complications.[2]
Summary
Despite an increasing emphasis on data-driven quality improvement, few validated quality indicators for emergency surgical services have been published. Acute biliary disease comprises a significant proportion of the general emergency surgical workload, with approximately 60,000 patients admitted to English NHS hospitals each year.[1] Previous meta-analyses have shown that early cholecystectomy improves outcomes for patients with acute biliary disease, resulting in a reduced total length of stay, faster recovery, reduced morbidity and reduced healthcare costs with no increased risk of complications.[2] As a result, international guidelines recommend early cholecystectomy for mild and moderate cholecystitis and definitive treatment (either cholecystectomy or endoscopic sphincterotomy) within two weeks of presentation with mild or moderate acute biliary pancreatitis.[3,4]. Many hospitals do not offer cholecystectomy in the acute phase and previous studies have shown that concordance with the British Society of Gastroenterology acute pancreatitis guidelines in the UK is low.[5,6] This is set against an international background in which there is an increasing emphasis on monitoring, improving and demonstrating the quality of surgical care,[7,8] with a
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