Assessment of quality of care in laparoscopic cholecystectomy.

With the advent of laparoscopic cholecystectomy, assessment of data and its relationship to quality of care became important. The Mount Sinai Hospital Medical Center conducted a prospective survey in conjunction with the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) National Survey. In this survey, only two surgeons operated as surgeon and co-surgeon with an extremely small rate of complication. A national survey of chairpersons in surgery was designed at Rush Presbyterian St. Luke's Hospital, and 4300 chairpersons were mailed questionnaires to record complications of laparoscopic cholecystectomy. There were 36,232 patients and 3111 surgeons in the survey. The Southern Surgeons Club experience, as reported in New England Journal of Medicine, was reviewed. Because of the complexity of understanding the implications of the survey results, the authors have arrived at a simplified system of evaluating quality of care in laparoscopic cholecystectomy. In this system only three considerations are taken into account: (a) elective conversions to standard operation, (b) forced conversions (due to iatrogenic injuries), and (c) reoperation rate (delayed complication). It is hoped that data collection will be simplified and more meaningful.