Evidence-based implementation regarding gallstone surgery. A register-based study
Linda Nilsson, Agnieszka Popowicz, Folke Hammarqvist, Gabriel SandblomAbstract
Introduction
Quality registers are important tools for surveillance of quality of care. When new surgical recommendations are introduced, compliance can be monitored in quality registers. The aim of this register-based study was to evaluate the implementation of new knowledge in gallstone surgery.
Methods
Data was retrieved for the period 2007–2024 from the Swedish National Register for Gallstone Surgery (GallRiks). We explored the following four issues: refraining from antibiotics as prophylaxis in uncomplicated cholecystectomies, surgery within 2 days after admission in acute cholecystectomy, intraoperative management of diagnosed choledocholithiasis, and operations during the acute admission rather than postponed to an elective procedure in patients with cholecystitis where an operation is indicated. For each outcome, the association between the outcome and year of procedure was tested with Pearson’s correlation test.
Results
For all four outcome variables, a statistically significant progress was seen during the years of study (all P < 0.01). There were interruptions in the trends for all outcomes, but changes were eventually and gradually adopted after the guidelines were adjusted.
Discussion
GallRiks quality register provides support for standardization and quality assurance of treatment strategies for patients with gallstone disease. During the study period, a change was seen regarding all treatment routines evaluated. To some extent, this was probably due to compliance with treatment recommendations. However, it is difficult to determine the extent to which the changes were due to alignment with guidelines or due to adaptations of routines for local reasons.