The Impact of a Surgical Unit's Structure and Operative Technique on Quality in Two Swedish Rural Hospitals.

Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure with a low complication rate. It is performed either as an acute or as an elective procedure. Most elective LCs are performed on nonlethal diseases and this is why good quality is important. Our study compared the quality of LC in two surgical units in northern Sweden (Sundsvall and Östersund) which use different clinical structures (subspecialised vs. general surgery) and surgical techniques (ultrasound fundus first vs. conventional diathermy). The study aimed to investigate whether these differences affected the quality of outcomes after LC. This is a registry-based study which included 607 elective LCs from January 2014 to May 2016. There were 286 from Sundsvall and 321 from Östersund. Primary outcomes were operative time and the percentage of day surgeries. The secondary outcome was the presence of postoperative complications within the first 30 days in terms of bile duct injury, bleeding that necessitated reoperation, bile leakage and abscesses treated with drainage and mortality. The time length of surgery was shorter in Sundsvall (mean 48.3 min) compared to Östersund (mean 108.6 min,  < 0.001. The percentage of day care surgeries was 94% in Sundsvall and 23% in Östersund,  < 0.001. Six patients (2.1%) had a complication in Sundsvall compared to seven patients (2.2%) in Östersund,  = 1.00. There is a significant difference between the two hospitals regarding operative time and the percentage of day surgeries. Complication rates in both units were equal and low.