Textbook outcome in the surgical treatment of acute cholecystitis

Abstract

Background Textbook Outcome (TO) is a novel composite measure of clinical outcomes that can be used to measure the quality of surgical outcomes. The aim of this cohort study was to propose TO criteria for laparoscopic cholecystectomy for acute cholecystitis and to identify reasons for TO failure and individual patient factors that predispose to failure. Methods We retrospectively analyzed data for 189 consecutive patients with acute cholecystitis who underwent laparoscopic cholecystectomy. TO was defined as laparoscopic cholecystectomy without conversion to open cholecystectomy, intraoperative complications, postoperative complications (Clavien–Dindo classification ≥ 2), prolonged length of stay (≥ 10 days), readmission within 30 days, or mortality. Demographic and clinical differences between patients with and without TO were compared using univariate and multivariate analyses. Results TO was achieved in 81% (n = 154) of 189 patients who underwent laparoscopic cholecystectomy for acute cholecystitis. Medical costs were lower in the TO-achieved group than in the TO-failure group. Factors associated with TO on univariate analysis were age, vascular disease, history of malignant tumor treatment, white blood cell count, hemoglobin, C-reactive protein, albumin, gallbladder perforation, and > 3 days since the onset of symptoms. Factors on multivariate analysis were age > 70 years, hemoglobin < 11.9 g/dl, and white blood cells > 18,000 / µl (all P < 0.05). Conclusions Applying TO to patients with acute cholecystitis allowed us to evaluate the overall quality of care related to hospitalization. TO may provide better assessment of the quality of care and help determine the treatment choice and reduce costs.