Elective cholecystectomy benchmarks: nationwide registry study

Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study was to establish clinically relevant benchmarks for elective laparoscopic cholecystectomy (ELC) to guide quality initiatives and support improvements in patient outcomes.

The Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography provided data on patients treated with primary ELC for a benign indication between 2015 and 2023. Exclusion criteria were common bile duct stones or stents detected before surgery, suspicion of bile duct obstruction, abnormal or unperformed intraoperative cholangiogram, previous major upper abdominal surgery, concomitant surgical procedures, and robotic surgery. The Achievable Benchmark of Care methodology was used to develop intra- and postoperative benchmarks, with severe postoperative complications (Clavien-Dindo ≥ III) representing the primary outcome. During surgery, serious adverse events were defined as intestinal perforation, bile leakage, or bleeding requiring transfusion or conversion to open surgery. Postoperative outcomes were assessed up to 30 days after surgery. Logistic regression identified risk factors for severe postoperative complications.

Overall, 48 564 patients undergoing ELCs across 81 surgical facilities were included. Among these, 69% were women. Median age was 50 (range 18-95) years and 91.4% were classified as American Society of Anesthesiologists classification ≤ II. Ten benchmarks were developed, capturing either intraoperative events (3) or postoperative complications (7). During surgery, 0.5% of the total cohort experienced a serious adverse event (median 0.3%, interquartile range 0.2-0.7% between facilities)-benchmark was 0.2%. Severe postoperative complications occurred in 1.7% of patients (median 1.6%, interquartile range 1.0-2.2% between facilities)-benchmark was 1.0%. Postoperative mortality was low (7 deaths, < 0.1%). At multivariable analysis, American Society of Anesthesiologists classification ≥ III (odds ratio 1.35, 95% confidence interval 1.05 to 1.72; P = 0.018), previous abdominal surgery (odds ratio 2.15, 1.24 to 3.75; P = 0.007), and intraoperative assessment of an altered gallbladder morphology (odds ratio 1.24, 1.01 to 1.52; P = 0.044) were independently associated with severe postoperative complications.

This study provides benchmarks for elective laparoscopic cholecystectomy. When compared with real-world performance, these benchmarks highlight potential areas for quality improvement.