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Indications for cholecystectomy: the results of a consensus panel approach
G M Fraser1, D Pilpel, S Hollis
1Department of Gastroenterology, Soroka Medical Center, Beer-Sheba, Israel.
Insights
A consensus panel developed a list of appropriate clinical indications for cholecystectomy (gallbladder removal). Panel discussions improved agreement on when gallbladder surgery is medically appropriate.
Area of Science:
- Medical consensus building
- Surgical indications
- Health policy development
Background:
- Developing standardized clinical indications for cholecystectomy is crucial for appropriate patient care.
- Physician consensus is vital for establishing guidelines in surgical procedures.
Framework:
- A consensus panel approach was utilized to define appropriate indications for cholecystectomy.
- Indications were scored on a scale of 1 (inappropriate) to 9 (appropriate) considering comorbidity levels.
- Definitions of agreement and disagreement were established to guide the consensus process.
Implementation:
- Nine physicians from diverse disciplines scored 266 clinical indications for cholecystectomy.
- Panelists convened to discuss, modify, and rescore indications, refining the list.
- Gastroenterologists showed less surgical recommendation compared to surgeons and internists.
Implications:
- The panel composition and agreement definitions significantly influenced the final list of appropriate cholecystectomy indications.
- Post-discussion, agreement on appropriate indications increased from 39% to 46% (p < 0.08).
- Disagreement decreased from 27% to 18% (p < 0.01), with 59 indications achieving consensus.
Abstract:
A consensus panel approach was used in Israel to develop a list of clinical indications for which there was agreement that cholecystectomy should be performed. Nine physicians from different disciplines were asked to score a list of 266 clinical indications for cholecystectomy. Each indication was scored on a scale of 1 (inappropriate, i.e. health risks exceed health benefits) to 9 (appropriate, i.e. benefits exceed risks). Each indication also included one of four comorbidity levels (none to high). Agreement and disagreement were defined and panelists met to discuss, modify and rescore the list. The composition of the panel and definitions of agreement had a considerable impact on the preparation of a list of agreed, appropriate indications for cholecystectomy. Gastroenterologists in the panel were less likely to recommend surgery than either surgeons or general internists both before and after the panel discussion. Following the discussion the level of agreement (defined as after discarding the highest and lowest score all of the remaining seven panelists were in a 3-point range) increased from 39% to 46% (p < 0.08) and disagreement decreased from 27% to 18% (p < 0.01). Fifty-nine of the 266 indications were considered appropriate with agreement.