Background: Practice variation generally raises concerns about the quality of care. This study determined the longitudinal degree of hospital variation in proportion of patients with gallstone disease undergoing cholecystectomy, while adjusted for case-mix, and the effect on clinical outcomes. Methods: A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands in 2013–2015. Patients with gallstone disease were collected from the diagnosis-related group database. Hospital variation in case-mix-adjusted cholecystectomy rates was calculated per year. Clinical outcomes after cholecystectomy were compared between hospitals in the lowest/highest 20th percentile of the distribution of adjusted cholecystectomy rates in all 3 subsequent years. Results: In total, 96,673 patients with gallstones were included. The cholecystectomy rate was 73.6%. In 2013–2015, the case-mix-adjusted performance of cholecystectomies was in hospitals with high rates 1.5–1.6 times higher than in hospitals with low rates. Hospitals with a high adjusted cholecystectomy rate had a higher laparoscopy rate, shorter time to surgery, and less emergency department visits after a cholecystectomy compared to hospitals with a low-adjusted cholecystectomy rate. Conclusion: Hospital variation in cholecystectomies in the Netherlands is modest, cholecystectomy rates varies by <2-fold, and variation is stable over time. Cholecystectomies in hospitals with high adjusted cholecystectomy rates are associated with improved outcomes.

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荷兰胆囊切除术的医院变异：一项全国性观察研究

背景：实践差异通常会引起对护理质量的担忧。该研究确定了接受胆囊切除术的胆结石患者比例的医院变异程度，同时调整了病例组合，以及对临床结果的影响。方法：2013-2015 年在荷兰所有医院进行了一项全国性的纵向数据库研究。从诊断相关组数据库中收集胆结石病患者。每年计算病例组合调整胆囊切除术率的医院变化。在随后的所有 3 年中，在调整后胆囊切除术率分布的最低/最高 20% 的医院之间比较了胆囊切除术后的临床结果。结果：共纳入 96,673 名胆结石患者。胆囊切除率为73.6%。2013-2015 年，胆囊切除术在病例组合调整后的表现在高比率医院是低比率医院的 1.5-1.6 倍。与调整胆囊切除率低的医院相比，调整胆囊切除率高的医院腹腔镜检查率更高，手术时间更短，胆囊切除术后急诊就诊次数更少。结论：荷兰胆囊切除术的医院变化不大，胆囊切除术的变化率小于 2 倍，并且随着时间的推移变化是稳定的。在调整后胆囊切除术率高的医院进行胆囊切除术与改善结果相关。比低费率医院高 6 倍。与调整胆囊切除率低的医院相比，调整胆囊切除率高的医院腹腔镜检查率更高，手术时间更短，胆囊切除术后急诊就诊次数更少。结论：荷兰胆囊切除术的医院变化不大，胆囊切除术的变化率小于 2 倍，并且随着时间的推移变化是稳定的。在调整后胆囊切除术率高的医院进行胆囊切除术与改善结果相关。比低费率医院高 6 倍。与调整胆囊切除率低的医院相比，调整胆囊切除率高的医院腹腔镜检查率更高，手术时间更短，胆囊切除术后急诊就诊次数更少。结论：荷兰胆囊切除术的医院变化不大，胆囊切除术的变化率小于 2 倍，并且随着时间的推移变化是稳定的。在调整后胆囊切除术率高的医院进行胆囊切除术与改善结果相关。荷兰胆囊切除术的医院变化不大，胆囊切除术的变化率小于 2 倍，并且随着时间的推移变化是稳定的。在调整后胆囊切除术率高的医院进行胆囊切除术与改善结果相关。荷兰胆囊切除术的医院变化不大，胆囊切除术的变化率小于 2 倍，并且随着时间的推移变化是稳定的。在调整后胆囊切除术率高的医院进行胆囊切除术与改善结果相关。