Defining the ideal outcome for gallbladder surgery: a collaborative approach

The international surgical community has not reached a consensus on selecting patients with abdominal pain and gallstones for surgery, while gallstones become an increasing problem in a more obese society. Approximately 15-20% of the general population has gallstones, and 20% of people with gallstones develop symptoms. In a minority of patients, gallstones can lead to a complication, for example, an infected gallbladder. Dutch surgeons remove approximately 26000 gallbladders annually. From a surgical perspective, a keyhole procedure for gallbladder removal is safe and effective. However, patient views are less incorporated in outcome measures of gallbladder surgery. To optimise treatment outcomes, it is favourable to consider all perspectives.

Floris Thunnissen, Daan Comes, Carmen Latenstein, Martijn Stommel, Kees van Laarhoven, Philip de Reuver (Department of Surgery), Joost Drenth, Marten Lantinga (Department of Gastroenterology) and Femke Atsma (IQ-Healthcare) set out to find an all-encompassing ideal- or ‘Textook outcome’, according to clinicians and patients. To achieve consensus, the group established an international collaboration with international scientific societies,  (inter)national surgeons and gastroenterologists, and patients.

First, focus groups were organised with patients and clinicians to list all possible outcomes of treatment of gallstone disease. Next, reported outcomes were surveyed among patients and clinicians. Outcomes became part of the Textbook outcome if there was consensus among patients and clinicians.

490 Dutch patients and 603 clinicians from 81 different countries completed the survey. Based on the survey results and a final expert meeting the consensus-based Textbook outcome is defined as no hospital admission for recurrent pain attacks, absence or relief of abdominal pain after treatment, and absence of surgical or gallstone-related complications.

The researchers hope that the defined Textbook outcome is a better way to assess the success of gallbladder surgery in patients with abdominal pain. The Textbook outcome can be used as a benchmark for surgeons, hospitals and healthcare policymakers. 

Read the study here

Thunnissen, F. M., Comes, D. J., Latenstein, C. S., Stommel, M. W., van Laarhoven, C. J., Drenth, J. P., Lantinga, M. A., Atsma, F., de Reuver, P. R. (2023) A mixed-methods study to define Textbook Outcome for the treatment of patients with uncomplicated symptomatic gallstone disease with hospital variation analyses in Dutch trial data. HPB.