Veen Eelco J, Bik Marianne, Janssen-Heijnen Maryska L G, De Jongh Maryska, Roukema Anne J
Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands.
Int J Qual Health Care. 2008 Apr;20(2):144-51. doi: 10.1093/intqhc/mzm073. Epub 2008 Jan 24.
The aim was to assess and discuss the utility of a complication registry for determining outcome and delivered care in surgery.
All patients with Laparoscopic Cholecystectomy between 1998 and 2006 were analysed. Complications were prospectively documented and evaluated according to outcome measures mentioned in literature (bile duct injury, morbidity, mortality and conversion rate) for Laparoscopic Cholecystectomy. In addition, all patient files were evaluated for possible risk factors and non-registered complications.
One thousand two hundred fifty four Laparoscopic Cholecystectomies were performed, with 207 complications in 152 (12%) patients. Eighteen (9%) events were additionally found after evaluating all medical files. Thirteen (1%) bile duct injuries occurred, 7% (n = 91) morbidity, no mortality and 18% (n = 226) conversion rate. The probability of complications was significantly higher in patients diagnosed with complicated gallstone disease, ASA 3/4, > 70 years, acute and converted procedures. Thirty % (n = 63) of all documented adverse events reflected issues other than traditionally mentioned outcome measures, categorised as hospital-provider errors or miscellaneous.
Ninety % of all complications in laparoscopic cholecystectomy were documented in our registry. Factors associated with a high probability of complications were identified and 30% of all events reflected issues other than traditionally mentioned outcome measures for Laparoscopic Cholecystectomy. The registry can be used for outcome measurement, however differences in case mix and data collection methods should be taken into account.
评估并讨论并发症登记册在确定手术结局及所提供治疗方面的效用。
对1998年至2006年间所有接受腹腔镜胆囊切除术的患者进行分析。根据文献中提及的腹腔镜胆囊切除术的结局指标（胆管损伤、发病率、死亡率和转化率），对并发症进行前瞻性记录和评估。此外，对所有患者病历进行评估，以查找可能的风险因素和未登记的并发症。
共进行了1254例腹腔镜胆囊切除术，152例（12%）患者出现207例并发症。在评估所有病历后，又发现了18例（9%）事件。发生了13例（1%）胆管损伤，发病率为7%（n = 91），无死亡病例，转化率为18%（n = 226）。被诊断为复杂性胆结石疾病、美国麻醉医师协会（ASA）分级为3/4级、年龄>70岁、急性手术和中转手术的患者发生并发症的概率显著更高。所有记录的不良事件中有30%（n = 63）反映了传统提及的结局指标以外的问题，归类为医院-提供者错误或其他杂项。
我们的登记册记录了腹腔镜胆囊切除术中90%的并发症。确定了与高并发症概率相关的因素，所有事件中有30%反映了腹腔镜胆囊切除术传统提及的结局指标以外的问题。该登记册可用于结局测量，但应考虑病例组合和数据收集方法的差异。
