Effect of panel composition on appropriateness ratings.

Cholecystectomy is performed frequently and for relatively few indications. An all surgical panel agreed on more indications and fewer contra-indications for cholecystectomy than a mixed specialty panel but did not approve indications for patients with higher comorbidity. In mixed panels subspecialists (gastroenterologists) were more conservative than generalists and surgeons. Similar findings have been shown for carotid endarterectomy. Comparing the results of British and Israeli panels showed variations in rating appropriateness that indicate differences in approach between countries. We conclude that the composition of panels will influence the assessment of appropriateness.