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Cholelithiasis is a common condition characterized by the presence of stones in the gallbladder and/or bile ducts; it primarily affects women, with a female-to-male ratio of 2:1. Acute cholecystitis is an acute inflammation of the gallbladder wall, accompanied by cholelithiasis in 95% of cases; the chronic form is often characterized by recurrent colic and a contracted, fibrotic, thickened gallbladder.

Cholelithiasis, with or without cholecystitis, is a major reason for abdominal surgery. The procedure can be performed laparoscopically or openly (laparotomy). Laparoscopic cholecystectomy is now considered the gold standard for the treatment of gallstones in uncomplicated cases. A systematic review of randomized controlled trials found no significant difference in mortality or complications between laparoscopic and open techniques. The former, however, is associated with a significantly shorter hospital stay and recovery time than traditional open surgery.

A condition associated with a higher risk of complications is the presence of stones in the common bile duct. One of the complications of cholecystectomy is bile duct injury, which, in the case of laparoscopic surgery, occurs in 0.5-1% of cases. Conversion from laparoscopic surgery to traditional laparotomy is performed when the surgeon determines that continuing with laparoscopic surgery increases the risk of complications for the patient.

The conversion rate in the international literature varies from 0.6 to 13% and is significantly influenced by the experience of the surgical team. An analysis of systematic reviews in the literature highlighted a statistically significant association between cholecystectomy volume and outcomes, without, however, identifying a volume threshold. The indicators “Complications within 30 days of routine laparoscopic cholecystectomy” and “Other intervention within 30 days of routine laparoscopic cholecystectomy” measure the short-term outcomes of routine laparoscopic cholecystectomy performed as an inpatient and can be considered good indicators of the quality of surgical facilities. Another outcome measure, widely used in the literature to evaluate facility performance, concerns the length of postoperative hospital stay.

For this reason, the indicator “Laparoscopic cholecystectomy: postoperative hospital stay less than 3 days” is calculated, since the literature generally defines postoperative hospital stay after laparoscopic cholecystectomy as between 3 and 5 days. The Ministry of Health Decree of April 2, 2015, no. 70 on hospital care standards, for the proportion of laparoscopic cholecystectomies with a postoperative hospital stay of less than three days, sets a minimum threshold of 70%.

Because they are calculated based on information from hospital discharge records, which only rarely report double procedures, these indicators cannot account for any conversion from laparoscopic to laparotomy. Since the literature is well-known for the heterogeneity in the provision of day-care procedures across facilities and populations, due in part to factors such as age, severity of cholelithiasis, or patient comorbidities, the indicator “Laparoscopic cholecystectomy: proportion of day-care admissions” is calculated, which measures the proportion of procedures performed as day-care procedures or as day-care procedures.

The heterogeneity of care provision is also assessed at the patient’s area of ​​residence by calculating the indicators “Hospitalization for cholecystectomy” and “Hospitalization for cholecystectomy in patients with simple cholelithiasis without complications.” The values ​​of these indicators may vary between regions and facilities; this phenomenon, in addition to differences in quality of care, may be caused by the heterogeneous distribution, due to case mix, of various patient-related risk factors.

The indicators are therefore adjusted for age, severity of cholelithiasis, and a series of comorbidities that can influence the outcome of the interventions.

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