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Emergency management of gallbladder disease: Are acute surgical units the new gold standard?
Shakerian, Rose Skandarajah, Anita Gorelik, Alexandra Thomson, Benjamin N. J.
Shakerian, Rose
Skandarajah, Anita
Gorelik, Alexandra
Thomson, Benjamin N. J.
Abstract
Introduction Since 2011, all acute general surgical admissions have been managed by the consultant-led emergency general surgery service (EGS) at our institution. We aim to compare EGS management of acute biliary disease to its preceding model. Materials and methods Retrospective review of prospectively collated databases was performed to capture consecutive emergency admissions with biliary disease from 1st February 2009 to 31st January 2013. Patient demographics, surgical intervention, use of diagnostic radiology, histological diagnosis, complications and hospital length of stay (LOS) were retrieved. Results A total of 566 patients were included (pre-EGS 254 vs. EGS 312). In the EGS period, the number of patients having surgery on index admission increased from 43.7 to 58.7 % (p < 0.001) as did use of intra-operative cholangiography from 75.7 to 89.6 % (p = 0.003). The conversion to open cholecystectomy rate also was reduced from 14.4 to 3.3 % (p < 0.001). Overall, a 14 % reduction in use of multiple (>1) imaging modalities for diagnosis was noted (p = 0.003). There was a positive trend in reduction of bile leaks but no significant difference in the overall morbidity and mortality. Time to theatre was reduced by 1 day [pre-EGS 2.7 (IQR 1.5–5.0) vs. EGS 1.7 (IQR 1.2–2.6) p < 0.001]. The overall hospital LOS was reduced by 1.5 days [pre-EGS 5.0 (IQR 3–7) vs. EGS 3.5 (IQR 2–5) p < 0.001]. Conclusion Since the advent of EGS, more judicious use of diagnostic radiology, reduced complications, reduced LOS, reduced time to theatre and an increased rate of definitive management during the index admission were demonstrated.
Keywords
choledocholithiasis, index admission, biliary disease, magnetic resonance cholangiography, percutaneous cholecystostomy
Date
2015
Type
Journal article
Journal
World Journal of Surgery
Book
Volume
39
Issue
11
Page Range
2636-2640
Article Number
ACU Department
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled