Cholecystectomy peer review: measurement of four variables.

Process and outcome analyses were carried out on a group of patients who had uncomplicated cholecystectomy. The postoperative length of stay and patient satisfaction were also measured. A random sample of 80 charts was selected from 222 eligible records for process analysis. Outcome was evaluated in 218 of the 222 eligible patients against explicit criteria. More patients were in the symptomatic and back-to-work group than expected. The peer consensus was that these results were not related to the surgical procedure or specifically related to gallbladder disease. Ninety-five per cent of the patients assessed care as good or excellent, and 90 per cent felt the length of postoperative stay was satisfactory. When the patients were divided according to surgeon, significant differences in the length of postoperative stay were found in the 154 patients without common bile duct exploration. After the findings were presented to the surgeons through an educational program, changes occurred which resulted in a decrease of nearly one day in the postoperative hospitalization.