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Protocol for a multicentre, prospective, population-based cohort study of variation in practice of cholecystectomy
Ravinder S Vohra1, Philip Spreadborough2, Marianne Johnstone2
1West Midlands Research Collaborative, University of Birmingham, Birmingham, UK Academic Department of Surgery, University of Birmingham, Birmingham, UK Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Insights
This study examines how hospital practices impact cholecystectomy outcomes, analyzing readmission and complication rates across UK and Irish centers. Findings will inform National Health Service (NHS) improvements for gallbladder surgery.
Area of Science:
- General Surgery
- Surgical Outcomes Research
- Health Services Research
Background:
- Cholecystectomy is a common surgical procedure with variable practice patterns among surgeons and hospitals.
- Existing population-level data suggest differences in surgical outcomes, but the impact of hospital variations is unclear.
- This study addresses the need to understand how hospital-level surgical provision influences patient outcomes.
Purpose of the Study:
- To investigate surgical outcomes following acute, elective, and delayed cholecystectomies.
- To determine if variations in hospital practices correlate with differences in patient outcomes.
- To provide evidence for informing commissioning groups and implementing changes within the National Health Service (NHS).
Main Methods:
- A multicentre, prospective, population-based cohort study involving UK and Irish hospitals.
- Recruitment of hospitals through trainee-led research collaboratives, collecting data on over 8000 consecutive adult patient procedures.
- Primary outcome: all-cause 30-day readmission rate; secondary outcomes: 30-day complication rates, bile leak, common bile duct injury, conversion to open surgery, duration of surgery, and length of stay.
Main Results:
- Data collection from a large cohort of over 8000 cholecystectomy procedures across multiple centers is anticipated.
- Analysis will utilize regression modeling to identify variations in outcomes and adjust for confounders.
- Hospital-specific policies and service provision will be surveyed to correlate with surgical outcomes.
Conclusions:
- Understanding hospital-level variations in surgical provision is crucial for improving patient outcomes after cholecystectomy.
- The study's findings will be essential for evidence-based changes in gallbladder surgery management within the NHS.
- Dissemination through peer-reviewed publications and conference presentations will facilitate knowledge sharing among surgical professionals.
Introduction:
Cholecystectomy is one of the most common general surgical operations performed. Despite level one evidence supporting the role of cholecystectomy in the management of specific gallbladder diseases, practice varies between surgeons and hospitals. It is unknown whether these variations account for the differences in surgical outcomes seen in population-level retrospective data sets. This study aims to investigate surgical outcomes following acute, elective and delayed cholecystectomies in a multicentre, contemporary, prospective, population-based cohort.
Methods And Analysis:
UK and Irish hospitals performing cholecystectomies will be recruited utilising trainee-led research collaboratives. Two months of consecutive, adult patient data will be included. The primary outcome measure of all-cause 30-day readmission rate will be used in this study. Thirty-day complication rates, bile leak rate, common bile duct injury, conversion to open surgery, duration of surgery and length of stay will be measured as secondary outcomes. Prospective data on over 8000 procedures is anticipated. Individual hospitals will be surveyed to determine local policies and service provision. Variations in outcomes will be investigated using regression modelling to adjust for confounders.
Ethics And Dissemination:
Research ethics approval is not required for this study and has been confirmed by the online National Research Ethics Service (NRES) decision tool. This novel study will investigate how hospital-level surgical provision can affect patient outcomes, using a cross-sectional methodology. The results are essential to inform commissioning groups and implement changes within the National Health Service (NHS). Dissemination of the study protocol is primarily through the trainee-led research collaboratives and the Association of Upper Gastrointestinal Surgeons (AUGIS). Individual centres will have access to their own results and the collective results of the study will be published in peer-reviewed journals and presented at relevant surgical conferences.
