A population-based survey of biliary surgery in Norway - Relationship between patient volume and quality of surgical treatment

Background: A registry was initiated in order to establish national standards for the quality of surgical treatment of gallstones, and to provide feedback to all hospitals about serious complications, in order to reduce their future incidence. Methods: Prospective registration of complications was performed at all hospitals and collected in the National Norwegian Cholecystectomy Registry (NNCR) over a period of 33 months. Results: Open cholecystectomy (OC) was performed in 1011 patients, and laparoscopic cholecystectomy (LC) in 4332 patients. These figures represent 68% of all procedures performed nationally. The frequency of bile duct (BD) injury was 0.8% for LC versus 0.7% for OC (ns); mortality was 0.1% versus 2.1%, respectively (p < 0.05), The frequency of ED injury and mortality were added; the sum comprised the Severe Complication Index (SCI). A linear relationship was found between SCI and patient volume (correlation coefficient, r(2)(2) = 0.78). Conclusions: SCI was found to be the best indicator of surgical success. We have proposed its use as a parameter for a future prospective quality assurance program, along with patient volume.