Utilization of cholecystectomy - A prospective outcome analysis in 1325 patients

The advent of laparoscopic techniques has resulted in an increased incidenc e of cholecystectomy, creating a need to reevaluate utilization. The new ou tcomes research movement emphasizes patient-derived data as well as traditi onal clinical outcomes. One of the purposes of this prospective study was t o seek possible correlations between a variety of variables, both patient- and physician-derived, to the patient's degree of overall satisfaction with the outcome. From July 1992 to May 1997, five different data collection fo rms were prospectively implemented-three physician-derived (preoperative, i ntraoperative, and postoperative) and two patient-derived sets of data. Ln the postoperative patient instrument, patients were asked to rate their deg ree of satisfaction with the outcome of their surgery on a scale of 1 to 5, with 5 being "extremely satisfied" and 1 being "not at all satisfied." We then sought differences between those patients rating their satisfaction as 5 vs, those rating their satisfaction as 1 to 3. Age, sex, and the presenc e of comorbid conditions did not correlate with eventual satisfaction. The following were correlated with a statistically significant better degree of satisfaction: the preoperative presence of known gallstones or a preoperat ive physician-derived history of typical biliary pain. No preoperative pati ent-derived data were associated with satisfaction; however, the postoperat ive presence of abdominal pain predicted dissatisfaction. Not surprisingly, continued problems with abdominal pain strongly correlated with dissatisfa ction, but this finding supports the accuracy of our assessment instrument. Furthermore, the more typical and clear-cut the clinical presentation, the greater the patient satisfaction with the outcome of cholecystectomy. Sati sfaction and pain relief are strongly associated. Ln patients with pain pre operatively, measurement of either pain relief or satisfaction may be adequ ate to assess correct utilization of this operative procedure.