{
    "abstract": "Cholecystectomy is one of the most frequently performed surgeries in Germany and is performed as a treatment of acute cholecystitis (guideline S3 IIIB.8) and after endoscopic retrograde cholangiopancreatography for choledocholithiasis with simultaneous cholecystolithiasis (guideline S3 IIIC.6). This article examines the effects of a guideline update from 2017, which recommends prompt cholecystectomy within 24\u2009hours of admission due to cholecystitis or within 72\u2009hours after bile duct repair. In addition, it aims to identify reasons (eg, financial disincentives) and potential for improvement for non-adherence to the guidelines.\nMethodologically, a retrospective analysis based on routine billing data from 84 Helios Group hospitals from 2016 and 2022, with a total of 45\u2009393 included cases, was applied. The guideline adherence rate is used as the main outcome measure.\nResults show the guideline updates led to a statistically significant increase in the proportion of cholecystectomy performed in a timely manner (guideline S3 IIIB.8: increase from 43% to 49%, p<0.001; guideline S3 IIIC.6: increase from 7% to 20%, p<0.001). Medical, structural and financial reasons for non-adherence could be identified.\nAs possible reasons for non-adherence, medical factors such as advanced age, multimorbidity and frailty could be identified. Analyses of structural factors revealed that hospitals in very rural regions are less likely to perform timely cholecystectomies, presumably due to infrastructural and personnel-capacity bottlenecks. A similar picture emerges for maximum-care hospitals, which might be explained by more severe and complex cases on average. Further evaluation indicates that an increase in and better hospital-internal participation of gastroenterologists in remuneration could lead to even greater adherence to the S3 IIIC.6 guideline.",
    "authors": [
        {
            "affiliation": "Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany leonard.fehring@uni-wh.de.\nGastroenterology, HELIOS Universit\u00e4tsklinikum Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany.",
            "firstname": "Leonard",
            "initials": "L",
            "lastname": "Fehring"
        },
        {
            "affiliation": "Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.",
            "firstname": "Hendrik",
            "initials": "H",
            "lastname": "Brinkmann"
        },
        {
            "affiliation": "Helios Health Institute GmbH, Leipzig, Germany.",
            "firstname": "Sven",
            "initials": "S",
            "lastname": "Hohenstein"
        },
        {
            "affiliation": "Helios Health Institute GmbH, Leipzig, Germany.",
            "firstname": "Andreas",
            "initials": "A",
            "lastname": "Bollmann"
        },
        {
            "affiliation": "Helios Health Institute GmbH, Leipzig, Germany.",
            "firstname": "Patrick",
            "initials": "P",
            "lastname": "Dirks"
        },
        {
            "affiliation": "Helios Health Institute GmbH, Leipzig, Germany.",
            "firstname": "J\u00f6rg",
            "initials": "J",
            "lastname": "P\u00f6litz"
        },
        {
            "affiliation": "Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.\nGastroenterology, HELIOS Universit\u00e4tsklinikum Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany.",
            "firstname": "Christian",
            "initials": "C",
            "lastname": "Prinz"
        }
    ],
    "conclusions": "As possible reasons for non-adherence, medical factors such as advanced age, multimorbidity and frailty could be identified. Analyses of structural factors revealed that hospitals in very rural regions are less likely to perform timely cholecystectomies, presumably due to infrastructural and personnel-capacity bottlenecks. A similar picture emerges for maximum-care hospitals, which might be explained by more severe and complex cases on average. Further evaluation indicates that an increase in and better hospital-internal participation of gastroenterologists in remuneration could lead to even greater adherence to the S3 IIIC.6 guideline.",
    "copyrights": "\u00a9 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
    "doi": "10.1136/bmjgast-2024-001439\n10.1016/j.ijsu.2015.04.083\n10.1055/a-0644-2972\n10.1016/S0140-6736(00)03156-1\n10.1097/SLA.0b013e3182a1599b\n10.1097/00000658-199804000-00001\n10.1046/j.1365-2168.1998.00708.x\n10.1016/s0002-9610(02)00789-4\n10.1016/s1091-255x(03)00065-9\n10.1046/j.1572-0241.2003.04002.x\n10.1007/s00464-003-9230-6\n10.1002/14651858.CD005440.pub2\n10.1002/bjs.6870\n10.1097/SLA.0b013e318228d31c\n10.1007/s00104-012-2356-0\n10.1097/SLA.0000000000001886\n10.1016/S0140-6736(02)09896-3\n10.1053/j.gastro.2005.10.015\n10.1053/j.gastro.2010.02.052\n10.1007/s00464-008-9764-8\n10.1053/j.gastro.2017.05.048\n10.1016/j.ajg.2014.01.005\n10.1503/cjs.008322\n10.1016/j.jml.2007.12.005\n10.18637/jss.v067.i01\n10.1080/01621459.1988.10478575\n10.1097/MLR.0000000000000735\n10.21105/joss.00648\n10.1007/s00104-022-01788-4\n10.1111/ans.17406\n10.1007/s11605-021-05157-0",
    "journal": "BMJ open gastroenterology",
    "keywords": [
        "BILE DUCT STONES",
        "CHOLECYSTECTOMY",
        "ENDOSCOPIC RETROGRADE PANCREATOGRAPHY"
    ],
    "methods": null,
    "publication_date": "2024-07-26",
    "pubmed_id": "39053927\n25958296\n30103223\n11089821\n24022431\n9563529\n9667702\n11943117\n12850677\n14687156\n15803229\n17054258\n20035546\n21817893\n23455587\n27741006\n12241833\n16401473\n20206179\n18270768\n28583822\n24630510\n37734850\n28498196\n36512029\n34859559\n34671914",
    "results": "Results show the guideline updates led to a statistically significant increase in the proportion of cholecystectomy performed in a timely manner (guideline S3 IIIB.8: increase from 43% to 49%, p<0.001; guideline S3 IIIC.6: increase from 7% to 20%, p<0.001). Medical, structural and financial reasons for non-adherence could be identified.",
    "title": "Timely cholecystectomy: important factors to improve guideline adherence and patient treatment.",
    "xml": "<Element 'PubmedArticle' at 0x788504e94680>"
}