The Impact of a Surgical Unit's Structure and Operative Technique on Quality in Two Swedish Rural Hospitals
2020 (English)In: Journal of investigative surgery, ISSN 0894-1939, E-ISSN 1521-0553, Vol. 33, p. 924-929Article in journal (Refereed) Published
Abstract [en]
Introduction: Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure with a low complication rate. It is performed either as an acute or as an elective procedure. Most elective LCs are performed on nonlethal diseases and this is why good quality is important. Our study compared the quality of LC in two surgical units in northern Sweden (Sundsvall and ostersund) which use different clinical structures (subspecialised vs. general surgery) and surgical techniques (ultrasound fundus first vs. conventional diathermy). The study aimed to investigate whether these differences affected the quality of outcomes after LC.
Materials and methods: This is a registry-based study which included 607 elective LCs from January 2014 to May 2016. There were 286 from Sundsvall and 321 from ostersund. Primary outcomes were operative time and the percentage of day surgeries. The secondary outcome was the presence of postoperative complications within the first 30 days in terms of bile duct injury, bleeding that necessitated reoperation, bile leakage and abscesses treated with drainage and mortality.
Results: The time length of surgery was shorter in Sundsvall (mean 48.3 min) compared to ostersund (mean 108.6 min, p < 0.001. The percentage of day care surgeries was 94% in Sundsvall and 23% in ostersund, p < 0.001. Six patients (2.1%) had a complication in Sundsvall compared to seven patients (2.2%) in ostersund, p = 1.00.
Conclusion: There is a significant difference between the two hospitals regarding operative time and the percentage of day surgeries. Complication rates in both units were equal and low.
Place, publisher, year, edition, pages
Taylor & Francis Group, 2020. Vol. 33, p. 924-929
Keywords [en]
laparoscopic cholecystectomy, operative technique, day surgery, complications, quality
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-157960DOI: 10.1080/08941939.2019.1579277ISI: 000461920800001PubMedID: 30885014Scopus ID: 2-s2.0-85096449213OAI: oai:DiVA.org:umu-157960DiVA, id: diva2:1305321
2019-04-162019-04-162023-03-23Bibliographically approved