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Title: Validation of the acute cholecystectomy rate as a quality indicator for emergency general surgery using the SWORD database.
Authors: Palser, Thomas R.
Navarro, Alex P.
Swift, Simon
Beckingham, Ian J.
First Published: 3-Jun-2019
Publisher: Royal College of Surgeons of England
Citation: Annals of The Royal College of Surgeons of England, 2019, 101(6), pp. 422-427
Abstract: Abstract Introduction – Despite an increasing emphasis on data-driven quality improvement, few validated quality indicators for emergency surgical services have been published. The aims of this study therefore were 1) to investigate whether the acute cholecystectomy rate is a valid process indicator and 2) use it to examine variation in the provision of acute cholecystectomy in England. Materials and Methods - The Surgical Workload and Outcomes Research Database (SWORD), (derived from the Hospital Episode Statistics (HES) database)) was interrogated for the 2012 – 2017 Financial Years. All adult patients admitted with acute biliary pancreatitis, cholecystitis or biliary colic to English Hospitals were included and the acute cholecystectomy rate in each examined. Results – 328, 789 patients were included, of whom 42,642 (12.9%) underwent an acute cholecystectomy. The acute cholecystectomy rate varied significantly between hospitals, with the overall rate ranging from 1.2% to 36.5%. This variation was consistent across all disease groupings and time periods and was independent of the annual number of procedures performed by each trust. In forty-one (29.9%) trusts, fewer than one in ten patients with acute gallbladder disease underwent cholecystectomy within two weeks. Conclusions – The acute cholecystectomy rate is easily measurable using routine administrative datasets, modifiable by local services and has a strong evidence base linking it to patient outcomes. We therefore advocate that it is an ideal process indicator that should be used in quality monitoring and improvement. Using it, we identified significant variation in the quality of care for acute biliary disease in England.
DOI Link: 10.1308/rcsann.2019.0042
ISSN: 0035-8843
Embargo on file until: 3-Jun-2020
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2019, Royal College of Surgeons of England. Deposited with reference to the publisher’s open access archiving policy. (
Description: The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above. Publisher version to be used.
Appears in Collections:Published Articles, Dept. of Health Sciences

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