Utilization of cholecystectomy-a prospective outcome analysis in 1325 patients

The advent of laparoscopic techniques has resulted in an increased incidence of cholecystectomy, creating a need to reevaluate utilization. The new outcomes research movement emphasizes patient-derived data as well as traditional clinical outcomes. One of the purposes of this prospective study was to seek possible correlations between a variety of variables, both patient- and physician-derived, to the patient's degree of overall satisfaction with the outcome. From July 1992 to May 1997, five different data collection forms were prospectively implemented-three physician-derived (preoperative, intraoperative, and postoperative) and two patient-derived sets of data. In the postoperative patient instrument, patients were asked to rate their degree of satisfaction with the outcome of their surgery on a scale of 1 to 5, with 5 being "extremely satisfied" and 1 being "not at all satisfied." We then sought differences between those patients rating their satisfaction as 5 vs. those rating their satisfaction as 1 to 3. Age, sex, and the presence of comorbid conditions did not correlate with eventual satisfaction. The following were correlated with a statistically significant better degree of satisfaction: the preoperative presence of known gallstones or a preoperative physician-derived history of typical biliary pain. No preoperative patient-derived data were associated with satisfaction; however, the postoperative presence of abdominal pain predicted dissatisfaction. Not surprisingly, continued problems with abdominal pain strongly correlated with dissatisfaction, but this finding supports the accuracy of our assessment instrument. Furthermore, the more typical and clear-cut the clinical presentation, the greater the patient satisfaction with the outcome of cholecystectomy. Satisfaction and pain relief are strongly associated. In patients with pain preoperatively, measurement of either pain relief or satisfaction may be adequate to assess correct utilization of this operative procedure.