Reviewer's report 
 Cholecystectomy in Sweden 2000 - 2003: a nationwide study on procedures, patient characteristics, Title: 
and mortality 
 3  12 March 2007 Version: Date: 
 Baki Topal Reviewer: 
Reviewer's report: 
General 
* This manuscript is valuable for the Swedish society and might be considered as a national audit that might 
be discussed and compared with other Western-European countries. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
* The authors should discuss the shortcomings of the national registry database; e.g. the exact indications 
for cholecystectomy, date of operation is not recorded but the authors were able to determine postoperative 
LOS; how?, outpatient cholecystectomy is not registered, how accurate is the registry (is there any 
validation of the data, who is responsible for registration ...?). 
* Discussion; looks like a summary of the literature upon some aspect of gallstone disease, and does not 
cover the real study. The authors should discuss their findings in the light of their conclusions, including the 
shortcomings of the study and recommendations 
* Conclusions; based on data presented it is not possible to compare laparoscopy vs. open cholecystectomy 
since there is most probably a major selection bias with respect to approach (laparoscopy or open), 
surgeon, hospital, emergency vs. planned procedure etc ... Either the authors should discuss these matters 
or present only descriptive statistics. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
* The authors use “age” and “previous admissions” as parameters to define frailty of the patients. However, 
this population can be considered as relatively young: the age in the laparoscopy group is 49y vs. 59y in the 
open group. They should provide data on ‘severity of illness’, patient characteristics, and on the number of elderly patients (>80y). * Numbers in the abstract don’t correspond with these in the text (n patients 43042 or 43072). 
* Results section is written more like a collection of legends, and needs to be presented as a text 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Not appropriate for BMC Medicine: an article whose findings are important to those with Which journal?: 
closely related interests and more suited to BMC Gastroenterology 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Reviewer's report 
 Cholecystectomy in Sweden 2000 - 2003: a nationwide study on procedures, patient characteristics, Title: 
and mortality 
 3  12 March 2007 Version: Date: 
 Baki Topal Reviewer: 
Reviewer's report: 
General 
* This manuscript is valuable for the Swedish society and might be considered as a national audit that might 
be discussed and compared with other Western-European countries. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
* The authors should discuss the shortcomings of the national registry database; e.g. the exact indications 
for cholecystectomy, date of operation is not recorded but the authors were able to determine postoperative 
LOS; how?, outpatient cholecystectomy is not registered, how accurate is the registry (is there any 
validation of the data, who is responsible for registration ...?). 
* Discussion; looks like a summary of the literature upon some aspect of gallstone disease, and does not 
cover the real study. The authors should discuss their findings in the light of their conclusions, including the 
shortcomings of the study and recommendations 
* Conclusions; based on data presented it is not possible to compare laparoscopy vs. open cholecystectomy 
since there is most probably a major selection bias with respect to approach (laparoscopy or open), 
surgeon, hospital, emergency vs. planned procedure etc ... Either the authors should discuss these matters 
or present only descriptive statistics. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
* The authors use “age” and “previous admissions” as parameters to define frailty of the patients. However, 
this population can be considered as relatively young: the age in the laparoscopy group is 49y vs. 59y in the 
open group. They should provide data on ‘severity of illness’, patient characteristics, and on the number of elderly patients (>80y). * Numbers in the abstract don’t correspond with these in the text (n patients 43042 or 43072). 
* Results section is written more like a collection of legends, and needs to be presented as a text 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Not appropriate for BMC Medicine: an article whose findings are important to those with Which journal?: 
closely related interests and more suited to BMC Gastroenterology 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Please review this paper.
user
Reviewer's report 
 Cholecystectomy in Sweden 2000 - 2003: a nationwide study on procedures, patient characteristics, Title: 
and mortality 
 3  12 March 2007 Version: Date: 
 Baki Topal Reviewer: 
Reviewer's report: 
General 
* This manuscript is valuable for the Swedish society and might be considered as a national audit that might 
be discussed and compared with other Western-European countries. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
* The authors should discuss the shortcomings of the national registry database; e.g. the exact indications 
for cholecystectomy, date of operation is not recorded but the authors were able to determine postoperative 
LOS; how?, outpatient cholecystectomy is not registered, how accurate is the registry (is there any 
validation of the data, who is responsible for registration ...?). 
* Discussion; looks like a summary of the literature upon some aspect of gallstone disease, and does not 
cover the real study. The authors should discuss their findings in the light of their conclusions, including the 
shortcomings of the study and recommendations 
* Conclusions; based on data presented it is not possible to compare laparoscopy vs. open cholecystectomy 
since there is most probably a major selection bias with respect to approach (laparoscopy or open), 
surgeon, hospital, emergency vs. planned procedure etc ... Either the authors should discuss these matters 
or present only descriptive statistics. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
* The authors use “age” and “previous admissions” as parameters to define frailty of the patients. However, 
this population can be considered as relatively young: the age in the laparoscopy group is 49y vs. 59y in the 
open group. They should provide data on ‘severity of illness’, patient characteristics, and on the number of elderly patients (>80y). * Numbers in the abstract don’t correspond with these in the text (n patients 43042 or 43072). 
* Results section is written more like a collection of legends, and needs to be presented as a text 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Not appropriate for BMC Medicine: an article whose findings are important to those with Which journal?: 
closely related interests and more suited to BMC Gastroenterology 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
assistant