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Outcomes From the Swedish Registry of Gallstone Surgery and ERCP (GallRiks). Clinical Consequences and Implementation During a 10-Year Period
Lars Enochsson*1, Gabriel Sandblom1, Johanna ÖSterberg2, Anders Thulin3, Bengt I. HallerbäCk4, Gunnar Persson5
1Department of Surgical Gastroenterology, Division of surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; 2Department of Surgery, Mora Hospital, Mora, Sweden; 3Department of Surgery, Halland Hospital, Halmstad, Sweden; 4Department of Surgery, NÄL Hospital, Trollhättan, Sweden; 5Department of Surgery, Ryhov Hospital, Jönköping, Sweden
Background
Cholecystectomy for symptomatic gallstone disease is one of the most common surgical procedures. Whereas the relative risk of postoperative complications is small, the absolute incidence is high due to widespread practice of gallstone surgery. In order to assess the intra- and postoperative complication rates, GallRiks started in May 2005 and now in 2015 celebrates its 10th anniversary. Since nearly 20,000 procedures (12,000 cholecystectomies and 7,500 ERCPs) are registered annually in constitutes a huge database available for clinical research.
The aim of this study is to present an overview of the clinical consequences and implementation that GallRiks research may have contributed to on patient Care during a 10-year period.
Material and Methods
A literature review on studies based on GallRiks data [1-4] and their clinical implications on the outcome and implementation on treatment strategies in cholecystectomy and ERCP during a 10-year period.
Results
In Sweden there were significant differences regarding the administration of prophylactic antibiotics for elective cholecystectomies. Lundström et al. [4] showed that the administration of prophylactic antibiotics did not reduce the postoperative infection rate. These findings have been presented at annual registry meetings as well as at national and international meetings before publication. The use of prophylactic antibiotics has decreased from 24 (2006) to 13% (2013). Another GallRiks study [3] showed that the risk of bleeding incresed with the use of systemic thromboembolic prophylaxis in laparoscopic cholecystectomy but had no effect on thromboembolic events. Since then thromboembolic prophylaxis in elective cholecystectomy has decreased from 49.7 (2006) to 25.4% (2013). A study on 51,041 cholecystectomies in GallRiks showed the intention to perform an intraoperative cholangiography reduced the risk of death after cholecystectomy [2]. The intraoperative cholangiography rate in Sweden has increased from 87.1 (2006) to 90.4% (2013). A study on 12,718 ERCP procedures in GallRiks [1] showed that intraoperative rendez-vous ERCP reduces the risk of post-ERCP pancreatitis from 3.6 to 2.2% compared with conventional biliary cannulation. The frequency of intraoperative ERCP in Sweden now has increased from 20 (2006) to 36% (2013).
Conclusion
The studies based on GallRiks data during this 10-year period have substantially changed the routines regarding treatment of patients with symptomatic gallstone disease in Sweden. A population-based register may improve the diffusion of evidence-based routines in the clinical care.
[1] Swahn F et al. The American journal of gastroenterology. 2013;108:552-9.
[2] Tornqvist B et al. Bmj. 2012;345:e6457.
[3] Persson G et al. The British journal of surgery. 2012;99:979-86.
[4] Lundstrom P et al. Journal of gastrointestinal surgery 2010;14:329-34.
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