Validation of postoperative period of care and Textbook Outcome as quality measures for gallstone surgery

Introduction A universally accepted quality measure for gallstone surgery is lacking. We performed a retrospective study where we evaluated the duration of postoperative care, completion with laparoscopic approach, absence of procedure-related complications, and no readmission as criteria for Textbook Outcome (TO). Method We collected data from the Swedish National Register for Gallstone Surgery (GallRiks) during the period 2007-2022. We analyzed postoperative stay as exposure and postoperative complications as outcome using Receiver Operation Characteristic (ROC). The definition of TO was laparoscopically completed operations, discharge within three days after surgery, no postoperative complication > Clavien-Dindo 2, no contact with the care provider or new readmission/intervention within 30 days post-surgery. The outcome of TO was further validated based on patients 6 months postoperatively answering SF-36. Result A total of 193 201 cholecystectomies were analyzed. The sensitivity was 50% and the specificity 87% for predicting a surgery-related complication using discharge within three days postoperatively as threshold. The rate of TO in the entire cohort was 79,4%. Patients who met the TO criteria rated notably higher on physical and mental scoring 6 months postoperatively (both p<0.05) compared to those that did not. Discussion For evaluating results after gallstone surgery, the postoperative period of care and TO can be considered robust outcome measures.