A POPULATION-BASED SURVEY OF BILIARY SURGERY IN NORWAY - RELATIONSHIPBETWEEN PATIENT VOLUME AND QUALITY OF SURGICAL-TREATMENT

Background: A registry was initiated in order to establish national st andards for the quality of surgical treatment of gallstones, and to pr ovide 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 Nat ional Norwegian Cholecystectomy Registry (NNCR) over a period of 33 mo nths. Results: Open cholecystectomy (OC) was performed in 1011 patient s, and laparoscopic cholecystectomy (LC) in 4332 patients. These figur es 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); mor tality was 0.1% versus 2.1%, respectively (p < 0.05), The frequency of ED injury and mortality were added; the sum comprised the Severe Comp lication 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 p roposed its use as a parameter for a future prospective quality assura nce program, along with patient volume.