[Bile leakage. A performance indicator with markedly different consequences for the patient, specialist and care...

Bile leakage following laparoscopic cholecystectomy for symptomatic cholelithiasis developed in 3 patients, two women aged 51 and 44, respectively, and a 45-year-old man. The first woman recovered after drainage and was discharged 1 day later. The second woman had persistent symptoms for several months but recovered after invasive examination and restorative surgery. The man died after 2 months of intensive therapy. The Netherlands Healthcare Inspectorate recently published a report on quality of care in Dutch healthcare institutions. Quality of care was assessed on the basis of a set of developed performance indicators, including bile leakage after laparoscopic cholecystectomy. The reported prevalence of bile leakage ranged between 0 and 7%; however, the cause, localisation and severity of the bile leakage and bile-duct injury were not reported. Bile leakage may be used as an indicator to identify hospitals in which this patient population should be analysed in more detail. This analysis could provide more information about the incidence of severe complications (such as bile-duct injury or transection) in order to analyse the quality ofcare. Bile leakage is not directly suitable for the comparison of quality of care by the general population.