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The European Journal of Public Health 2004 14(3):252-257; doi:10.1093/eurpub/14.3.252
© 2004 by European Journal of Public Health
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Health services

Appropriateness variation in cholecystectomy

José M. Quintana1, José Cabriada2, Ignacio López de Tejada3, Luis Perdigo4, Inmaculada Aróstegui5, Amaia Bilbao1 and Idoia Garay1

1 Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain 2 Servicio de Digestivo, Hospital de Galdakao, Galdakao, Vizcaya, Spain 3 Servicio de Cirugía, Hospital de San Eloy, Vizcaya, Spain 4 Servicio de Cirugía, Hospital de Cruces, Bilbao, Vizcaya, Spain 5 Departamento de Matemática Aplicada, Estadística e Investigación Operativa, Universidad del País Vasco, Lejona, Vizcaya, Spain

Background: Cholecystectomy use varies moderately across regions and countries. The purpose of this study was to evaluate the appropriateness of the use of cholecystectomy in patients with nonmalignant diseases in different hospitals using explicit criteria developed by an expert panel. Methods: Patients on waiting lists to undergo a cholecystectomy for nonmalignant diseases in six public hospitals in Spain were included in this prospective observational study over a 1-year period. Appropriateness criteria were first developed by a panel of experts using the RAND appropriateness method. The appropriateness of the indication was judged by applying explicit criteria developed previously. Complications were recorded 3 months after surgery. Results: After evaluation of 960 patients, 7 (0.7%) were considered to have undergone inappropriate procedures and 76 (7.9%) were judged to be uncertain. Differences were found in the rate of appropriateness among some centres (inappropriateness rate ranging from to 0 to 2.6%). No differences were found among the appropriateness categories for length of stay or complications, mortality, or readmission up to the third month after discharge. Conclusions: This study identified a low percentage of inappropriately performed cholecystectomies in our area. Even so, appropriateness differences among hospitals were found.

Keywords: cholecystectomy, health services research, hospitals, physician's practice patterns, utilization review

Received 13 November 2002. Accepted 12 May 2003.

* Correspondence: J.M. Quintana, MD, PhD, Unidad de Investigación, Hospital de Galdakao, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya, Spain, tel. +34 94 400 7105, fax +34 94 400 7132, e-mail: jmquinta{at}hgda.osakidetza.net


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