The Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks): A nationwide registry for quality assurance of gallstone surgery

Health-Related Quality-of-Life in a cohort undergoing cholecystectomy

INTRODUCTION

Patient-related outcome measures are crucial when assessing outcome from surgical intervention registers. The aim of this study was to analyse what factors affect Health-Related Quality of Life (HRQoL) in patients undergoing cholecystectomy, and to assess the feasibility of SF-36 as a HRQoL instrument in a patient register.

METHODS

The SF-36 questionnaire was distributed to patients preoperatively and 6-9 months after surgery. The outcome of patients who had undergone planned surgery between January 1, 2010 and June 30, 2011 at six units, with response rates of at least 100 per year, formed the basis for the present study. Expected outcome from a background population was determined from a Swedish cohort assembled previously.

RESULTS

Altogether 919 patients (646 women, 273 men) at the six units answered the questionnaire. Mean age was 52 years, standard deviation 15 years. Preoperatively, the surgery cohort rated lower on all subscales of the SF-36 than the age- and gender-matched background population. Postoperatively, they did not rate lower in any of the subscales. High age was associated with a significantly lower increase in bodily pain and Physical Component Summary (both p < 0.05). Open surgery was associated with a significantly lower increase in the Physical Component Summary (p < 0.05).

DISCUSSION

Regardless of indication for surgery, high age is associated with less benefit from surgery according to this questionnaire study. SF-36 is appropriate for measuring the impact of gallstone surgery on HRQoL.

Analysis of gallstone composition and structure in Jharkhand region

AIM

The aim of this study was to analyze gallstones structurally and chemically as this may help to direct the measures for its treatment.

METHODOLOGY

On the basis of morphology, 459 gallstones were categorized into pigmented, cholesterol, and mixed gallstones and analyzed for their chemical structure and composition. Elementary analysis was done with the help of inductively coupled plasma, optical emission spectrophotometry. Fourier transform infrared spectroscopy was used for compound analysis. The effects of thermal stability were analyzed by thermal gravimetric analysis (TGA). Statistical analysis was done to correlate gallstone composition with their shape and number in gallbladder.

RESULTS

Pigmented gallstones were predominant and generally occurred in multiple forms, cholesterol as solitaire and black pigmented as slug (χ (2) = 3.56; p < 0.001). Scanning electron microscopy showed the crystals of cholesterol in cholesterol gallstones while pigmented gallstones were more compact in structure. Both types of structure were seen in mixed stones while black pigmented stones were amorphous in nature. This difference in structures might be due to difference in chemical compositions. Cholesterol and mixed stones contained basically cholesterol, brown pigmented constituted bilirubin as a major component, and black stones differed from brown pigmented stones by the presence of Ca palmitate. Bilirubin and palmitate were thermally more stable than cholesterol; hence pigmented gallstones were thermally more stable than cholesterol gallstones, as seen in TGA study.

CONCLUSION

Pigmented gallstones were most common in this study of gallstones from the Jharkhand region.

Review of 103 Swedish Healthcare Quality Registries

BACKGROUND AND OBJECTIVES

In the past two decades, an increasing number of nationwide, Swedish Healthcare Quality Registries (QRs) focusing on specific disorders have been initiated, mostly by physicians. Here, we describe the purpose, organization, variables, coverage and completeness of 103 Swedish QRs.

METHODS

From March to September 2013, we examined the 2012 applications of 103 QRs to the Swedish Association of Local Authorities and Regions (SALAR) and also studied the annual reports from the same QRs. After initial data abstraction, the coordinator of each QR was contacted at least twice between June and October 2013 and asked to confirm the accuracy of the data retrieved from the applications and reports.

RESULTS

About 60% of the QRs covered ≥80% of their target population (completeness). Data recorded in Swedish QRs include aspects of disease management (diagnosis, clinical characteristics, treatment and lead times). In addition, some QRs retrieve data on self-reported quality of life (EQ5D, SF-36 and disease-specific measures), lifestyle (smoking) and general health status (World Health Organization performance status, body mass index and blood pressure).

CONCLUSION

Detailed clinical data available in Swedish QRs complement information from government-administered registries and provide an important source not only for assessment and development of quality of care but also for research.

Salmonella chronic carriage: epidemiology, diagnosis, and gallbladder persistence

Typhoid (enteric fever) remains a major cause of morbidity and mortality worldwide, causing over 21 million new infections annually, with the majority of deaths occurring in young children. Because typhoid fever-causing Salmonella have no known environmental reservoir, the chronic, asymptomatic carrier state is thought to be a key feature of continued maintenance of the bacterium within human populations. Despite the importance of this disease to public health, our understanding of the molecular mechanisms that catalyze carriage, as well as our ability to reliably identify and treat the Salmonella carrier state, have only recently begun to advance.

Antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial

BACKGROUND

Recent meta-analyses concluded that antibiotic prophylaxis is not warranted in low-risk laparoscopic cholecystectomy. However, most trials in the meta-analyses had a relatively small sample size and were statistically underpowered. In addition, many of the trials mentioned potential cost savings owing to the elimination of prophylactic antibiotics. However, no trial has statistically estimated the cost effectiveness. To evaluate the results of meta-analyses, we conducted a randomized controlled trial on the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy with an adequate sample size.

METHODS

From March 2007 to May 2013, at the Department of Surgery, Kansai Medical University, patients who were scheduled for elective laparoscopic cholecystectomy were randomly assigned to one of two arms: those who were and were not administered prophylactic antibiotics. The primary endpoint was the occurrence of postoperative infections and secondary endpoints were postoperative hospital stay and medical costs.

FINDINGS

During the study period, 518 patients were assigned to the Antibiotics group and 519 to the No antibiotics group. Occurrences of surgical site infections, distant infections and overall infections were significantly lower in the Antibiotics group than in the No antibiotics group (0.8 vs. 3.7%, p = 0.001, OR: 0.205 (95%CI: 0.069 to 0.606); 0.4 vs. 3.1%, p = 0.0004, OR: 0.122 (95%CI: 0.028 to 0.533); 1.2 vs. 6.7%; p<0.0001, OR: 0.162 (95%CI: 0.068 to 0.389), respectively). The postoperative hospital stay was significantly shorter in the Antibiotics group (mean, SD: 3.69±1.56 vs. 4.07±3.00; p = 0.01) and the postoperative medical costs were significantly lower in the Antibiotics group (mean, SD: $766±341 vs. 832±670; p = 0.047). Multivariable analysis showed that independent risk factors for postoperative infectious complications were no prophylactic antibiotics (p<0.0001) and age 65 or older (p = 0.006).

CONCLUSIONS

Perioperative administration of prophylactic antibiotics should be recommended in laparoscopic cholecystectomy to prevent postoperative infectious complications and to reduce medical costs.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000003749.