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Aranda-Nárvaez JM, Fernández-Galeano P, Romacho-López L, Cabrera-Serna I, Titos-García A, Mirón-Fernández I, Santoyo-Santoyo J. Improving early cholecystectomy rate in acute cholecystitis with an evidence-based local multidisciplinary protocol and a surgical audit: single-center experience through an Acute Care Surgery Division. Langenbecks Arch Surg 2024; 409:131. [PMID: 38634929 DOI: 10.1007/s00423-024-03305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To analyze if, after implementation of an evidence-based local multidisciplinary protocol for acute cholecystitis (AC), an intermediate surgical audit could improve early cholecystectomy (EC) rate and other therapeutic indicators. METHODS Longitudinal cohort study at a tertiary center. The local protocol, promoted, created, and periodically revised by the Acute Care Surgery Unit (ACSu) was updated and approved on March 2019. A specific registry was prospectively fulfilled with demographics, comorbidity, type of presentation, diagnostic items, therapeutic decision, and clinical course, considering both non-operative management (NOM) or cholecystectomy, early and delayed (EC and DC). Phase 1: April 2019-April 2021. A critical analysis and a surgical audit with the participation of all the involved Departments were then performed, especially focusing on improving global EC rate, considered primary outcome. Phase 2: May 2021-May 2023. Software SPSS 23.0 was used to compare data between phases. RESULTS Initial EC rate was significantly higher on Phase 2 (39.3%vs52.5%, p < 0.004), as a significantly inferior rate of patients were initially bailed out from EC to NOM because of comorbidity (14.4%vs8%, p < 0.02) and grade II with severe inflammatory signs (7%vs3%, p < 0.04). A higher percentage of patients was recovered for EC after an initial decision of NOM on Phase 2, but without reaching statistical significance (21.8%vs29.2%, n.s.). Global EC rate significantly increased between phases (52.5%vs66.3%, p < 0.002) without increasing morbidity and mortality. A significant minor percentage of elective cholecystectomies after AC episodes had to be performed on Phase 2 (14%vs6.7%, p < 0.009). Complex EC and those indicated after readmission or NOM failure were usually performed by the ACSu staff. CONCLUSION To adequately follow up the implementation of a local protocol for AC healthcare, registering and periodically analyzing data allow to perform intermediate surgical audits, useful to improve therapeutic indicators, especially EC rate. AC constitutes an ideal model to work with an ACSu.
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Affiliation(s)
- J M Aranda-Nárvaez
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain.
- Faculty of Medicine, Malaga University, Malaga, Spain.
| | - P Fernández-Galeano
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - L Romacho-López
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - I Cabrera-Serna
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - A Titos-García
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - I Mirón-Fernández
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - J Santoyo-Santoyo
- General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
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Fugazzola P, Bianchi CM, Calabretto F, Cicuttin E, Dal Mas F, Dominioni T, Maestri M, Mauro A, Podestà A, Tomasoni M, Brucchi F, Viganò J, Ansaloni L, Anderloni A, Cobianchi L. Intraoperative transcystic laparoscopic common bile duct stone clearance with SpyGlass™ discover during emergency and elective cholecystectomy: a single-center case series. World J Emerg Surg 2024; 19:8. [PMID: 38438899 PMCID: PMC10913229 DOI: 10.1186/s13017-023-00529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/13/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND STUDY AIM The development of a new cholangioscope, the SpyGlass™ Discover (Boston Scientific), has allowed the laparoscopic transcystic common bile duct exploration and stone clearance. The possibility of simultaneous treatment of choledocholithiasis during early laparoscopic cholecystectomy offers the opportunity to enormously reduce the time between acute cholecystitis diagnosis and the execution of cholecystectomy with better outcomes for patients. Furthermore, an altered anatomy of the gastrointestinal tract is not an obstacle to this technique. The aim of the study was to determine whether this new procedure is feasible, safe, and effective. PATIENTS AND METHODS The investigation employs a retrospective case series study including all consecutive patients with a diagnosis of common bile duct stones undergoing cholecystectomy and intraoperative laparoscopic common bile duct clearance using SpyGlass™ Discover at IRCCS Policlinico San Matteo in Pavia (Italy). Eighteen patients were included from May 2022 to May 2023. RESULTS A complete clearance of the common bile duct was obtained in 88.9% of patients. The mean postoperative length of stay was 3 days. No major complications occurred. After a median follow-up of 8 months, no recurrence of biliary events or readmissions occurred. CONCLUSION This procedure has proven to be feasible, safe, and effective.
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Affiliation(s)
- Paola Fugazzola
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy.
| | - Carlo Maria Bianchi
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
| | | | - Enrico Cicuttin
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Tommaso Dominioni
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - Marcello Maestri
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - Aurelio Mauro
- Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Podestà
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - Matteo Tomasoni
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
| | | | - Jacopo Viganò
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - Luca Ansaloni
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
| | - Andrea Anderloni
- Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Cobianchi
- Division of General Surgery, IRCCS Policlinico San Matteo Foundation, via Camillo Golgi 19, 27100, Pavia, PV, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
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Woong Choi JD, John Fong M, Shanmugalingam A, Aslam A, Aqeel Abbas Kazmi S, Kulkarni R, James Curran R. Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset. Turk J Surg 2023; 39:321-327. [PMID: 38694534 PMCID: PMC11057926 DOI: 10.47717/turkjsurg.2023.6165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/06/2023] [Indexed: 05/04/2024]
Abstract
Objectives There is growing evidence for reduced post-operative complications, and lower hospital costs associated with early cholecystectomy for acute calculus cholecystitis (AC) compared to delayed surgery. Limited high-quality evidence exists for how early, if at all, should surgeons be operating emergently for AC based on symptom onset. Material and Methods Seven hundred seventy-four patients who had cholecystectomy performed by a single surgeon between January 2015-October 2022 were retrospectively reviewed. Five hundred fourty-one patients were analysed. Patients were divided into three groups based on symptom onset: Group 1: 0-72 hours (n= 305), Group 2: 72 hrs-1 week (n= 154) and Group 3: >1 week (n= 82). Results Median operative time was most prolonged in Group 2 (96.5 minutes), and had the greatest proportion of reconstituting 95% cholecystectomies (n= 22/154, 14.29%) compared to Group 1 (p> 0.05). The conversion to open was between 0.65-1.64% in all groups. The greatest proportion of bile leak occurred in Group 1 (n= 7/305, 2.3%) followed by Group 3 (n= 1/82, 1.22%) (p> 0.05). All were successfully managed with ERCP and biliary stent. Median hospital stay was significantly prolonged in Group 2 (2.3 days) compared to Group 1 (2 days) (p= 0.03). The proportion of 95% cholecystectomies in Group 2 and 3 were not significant compared to Group 1. Conclusion Early cholecystectomy for calculus cholecystitis, irrespective of the timing of symptoms appears to have safe postoperative outcomes. Surgeons do not necessarily need to limit early cholecystectomy for within 72 hours of symptom onset.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
- Discipline of Surgery, University of Sydney Faculty of Medicine and Health, New South Wales, Australia
| | - Matthew John Fong
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Aswin Shanmugalingam
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Anoosha Aslam
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Syed Aqeel Abbas Kazmi
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Rukmini Kulkarni
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Richard James Curran
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
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Fugazzola P, Cobianchi L, Dal Mas F, Cicuttin E, Dominioni T, Frassini S, Tomasoni M, Viganò J, Catena F, Ansaloni L. Prospective validation of the Israeli Score for the prediction of common bile duct stones in patients with acute calculous cholecystitis. Surg Endosc 2023; 37:8562-8569. [PMID: 37794123 DOI: 10.1007/s00464-023-10442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Existing guidelines for predicting common bile duct stones (CBDS) are not specific for acute calculous cholecystitis (ACC). This paper is a posthoc analysis of the S.P.Ri.M.A.C.C study aiming to prospectively validate on a large independent cohort of patients the Israeli Score (IS) in predicting CBDS in patients with ACC. METHODS The S.P.Ri.M.A.C.C. study is an observational multicenter prospective study endorsed by the World Society of Emergency Surgery (WSES). Between September 1st, 2021, and September 1st, 2022, 1201 participants were included. The Chi-Square test was used to compare categorical data. A Cochran-Armitage test was run to determine whether a linear trend existed between the IS and the presence of CBDS. To assess the accuracy of the prediction model, the receiver operating characteristic (ROC) curve was generated, and the area under the ROC curve (AUC) was calculated. Logistic regression was run to obtain Odds Ratio (OR). A two-tailed p < 0.05 was considered statistically significant. RESULTS The rate of CBDS was 1.8% in patients with an IS of 0, 4.2% in patients with an IS of 1, 24.5% in patients with 2 and 56.3% in patients with 3 (p < 0.001). The Cochran-Armitage test of trend showed a statistically significant linear trend, p < 0.001. Patients with an IS of 3 had 64.4 times (95% CI 24.8-166.9) higher odds of having associated CBDS than patients with an IS of 0. The AUC of the ROC curve of IS for the prediction of CBDS was 0.809 (95% CI 0.752-0.865, p < 0.001). By applying the highest cut-off point (3), the specificity reached 99%, while using the lowest cut-off value (0), the sensitivity reached 100%. CONCLUSION The IS is a reliable tool to predict CBDS associated with ACC. The algorithm derived from the IS could optimize the management of patients with ACC.
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Affiliation(s)
- Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
| | - Lorenzo Cobianchi
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- ITIR - Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Enrico Cicuttin
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Simone Frassini
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Jacopo Viganò
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
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Fugazzola P, Abu-Zidan FM, Cobianchi L, Dal Mas F, Ceresoli M, Coccolini F, Frassini S, Tomasoni M, Catena F, Ansaloni L. Timing of Early Cholecystectomy for Acute Calculous Cholecystitis: A Multicentric Prospective Observational Study. Healthcare (Basel) 2023; 11:2752. [PMID: 37893826 PMCID: PMC10606750 DOI: 10.3390/healthcare11202752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
The definition of Early Cholecystectomy (EC) is still debatable. This paper aims to find whether the timing of EC affects outcomes. The article reports a multicentric prospective observational study including patients with acute calculous cholecystitis (ACC) who had cholecystectomy within ten days from the onset of symptoms. Kruskall-Wallis test, Fisher's Exact test, and Spearman rank correlation were used for statistical analysis. The patients were divided into three groups depending on the timing of the operation: 0-3 days, 4-7 days, or 8-10 days from the onset of symptoms. 1117 patients were studied over a year. The time from the onset of symptoms to EC did not affect the post-operative complications and mortality, the conversion, and the reintervention rate. The time represented a significant risk factor for intraoperative complications (0-3 days, 2.8%; 4-7 days, 5.6%; 8-10 days, 7.9%; p = 0.01) and subtotal cholecystectomies (0-3 days, 2.7%; 4-7 days, 5.6%; 8-10 days, 10.9%; p < 0.001). ACC is an evolutive inflammatory process and, as the days go by, the local and systemic inflammation increases, making surgery more complex and difficult with a higher risk of intraoperative complications. We recommend performing EC for ACC as soon as possible, within the first ten days of the onset of symptoms.
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Affiliation(s)
- Paola Fugazzola
- Fondazione IRCCS Policlinico San Matteo, Division of General Surgery, 27100 Pavia, Italy; (L.C.); (S.F.); (M.T.); (L.A.)
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, Italy
| | - Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates;
| | - Lorenzo Cobianchi
- Fondazione IRCCS Policlinico San Matteo, Division of General Surgery, 27100 Pavia, Italy; (L.C.); (S.F.); (M.T.); (L.A.)
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, Italy
- ITIR—Institute for Transformative Innovation Research, University of Pavia, 27100 Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice, 30123 Venice, Italy;
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy;
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, 56126 Pisa, Italy;
| | - Simone Frassini
- Fondazione IRCCS Policlinico San Matteo, Division of General Surgery, 27100 Pavia, Italy; (L.C.); (S.F.); (M.T.); (L.A.)
| | - Matteo Tomasoni
- Fondazione IRCCS Policlinico San Matteo, Division of General Surgery, 27100 Pavia, Italy; (L.C.); (S.F.); (M.T.); (L.A.)
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, 47521 Cesena, Italy;
| | - Luca Ansaloni
- Fondazione IRCCS Policlinico San Matteo, Division of General Surgery, 27100 Pavia, Italy; (L.C.); (S.F.); (M.T.); (L.A.)
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, Italy
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Kelly-Schuette KA, Chapman AJ, Messer LE, Kuk CC, Lypka MM, Krech LA, Pounders SJ, Iskander GA, Gibson CJ. Hotter Than It Looks: A Retrospective Review of Patients With Cholecystitis and With Negative Imaging. J Surg Res 2022; 273:93-99. [PMID: 35033822 DOI: 10.1016/j.jss.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/27/2021] [Accepted: 12/04/2021] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Ultrasound is the gold standard for workup of cholecystitis in the emergency department, and findings heavily influence clinical decision-making. Patients with negative imaging for acute cholecystitis may be inappropriately sent home. The purpose of our study was to review the pathology and outcomes of patients presenting with biliary pain and negative ultrasound findings of acute cholecystitis. MATERIALS AND METHODS Emergency department patients who underwent laparoscopic cholecystectomy between January 2015 and February 2019 were reviewed retrospectively. Only patients with negative or equivocal imaging were included. The primary outcome was the incidence of cholecystitis on final pathology. RESULTS Two hundred fifty-seven patients underwent laparoscopic cholecystectomy. Pathology demonstrated cholecystitis in 84% of patients. Only 15% of patients had cholelithiasis without cholecystitis on pathology. The incidence of cholecystitis was similar in negative and equivocal imaging groups (84% versus 83%; P = 0.960). The median time from admission to the operating room was 12.1 h (interquartile range 7.1-18.3 h), and hospital length of stay was 1.2 d (interquartile range 0.8-1.7 d). CONCLUSIONS This study found that patients with negative or equivocal imaging had cholecystitis on pathology. On review of patient outcomes, those patients who underwent surgical intervention had a low rate of complications and short hospital stay.
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Affiliation(s)
- Kathrine A Kelly-Schuette
- Spectrum Health, Michigan State University College of Human Medicine, General Surgery Residency, Grand Rapids, Michigan.
| | - Alistair J Chapman
- Spectrum Health Acute Care Surgery, Grand Rapids, Michigan; Spectrum Health Office of Research, Grand Rapids, Michigan
| | - Lauren E Messer
- Spectrum Health Trauma Research Institute, Grand Rapids, Michigan
| | - ChiuYing C Kuk
- Spectrum Health Trauma Research Institute, Grand Rapids, Michigan
| | - Matthew M Lypka
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Laura A Krech
- Spectrum Health Acute Care Surgery, Grand Rapids, Michigan; Spectrum Health Office of Research, Grand Rapids, Michigan
| | - Steffen J Pounders
- Spectrum Health Office of Research, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Gaby A Iskander
- Spectrum Health Acute Care Surgery, Grand Rapids, Michigan; Spectrum Health Office of Research, Grand Rapids, Michigan
| | - Charles J Gibson
- Spectrum Health Acute Care Surgery, Grand Rapids, Michigan; Spectrum Health Office of Research, Grand Rapids, Michigan; Spectrum Health Trauma Research Institute, Grand Rapids, Michigan
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Lascano D, Lai R, Stringel G, Stewart FD. Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy. JSLS 2021; 25:JSLS.2021.00047. [PMID: 34949908 PMCID: PMC8678762 DOI: 10.4293/jsls.2021.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population. Methods: The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was < 0.05. Results: A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p < 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386–2.673). Conclusion: Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery.
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Affiliation(s)
- Danny Lascano
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Rachel Lai
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Gustavo Stringel
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - F Dylan Stewart
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY
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Impact of Inter-Hospital Transfer on Outcomes in Patients Undergoing Emergency Abdominal Surgery: A Tertiary Referral Center's Perspective. World J Surg 2021; 45:2703-2711. [PMID: 34059929 PMCID: PMC8166360 DOI: 10.1007/s00268-021-06174-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In trauma patients, the impact of inter-hospital transfer has been widely studied. However, for patients undergoing emergency abdominal surgery (EAS), the effect of inter-hospital transfer on outcomes is largely unknown. METHODS This is a single-center, retrospective observational study. Outcomes of transferred patients undergoing EAS were compared to patients primarily admitted to a tertiary care hospital from 01/2016 to 12/2018 using univariable and multivariable analyses. The primary outcome was in-hospital mortality. RESULTS Some 973 patients with a median (IQR) age of 58.1 (39.4-72.2) years and a median body mass index of 25.8 (22.5-29.3) kg/m2 were included. The transfer group comprised 258 (26.3%) individuals and the non-transfer group 715 (72.7%). The population was stratified in three subgroups: (1) patients with low surgical stress (n = 483, 49.6%), (2) with hollow viscus perforation (n = 188, 19.3%) and (3) with potential bowel ischemia (n = 302, 31.1%). Neither in the low surgical stress nor in the hollow viscus perforation group was the transfer status associated with mortality. However, in the potential bowel ischemia group inter-hospital transfer was a predictor for mortality (OR 3.54, 95%CI 1.03-12.12, p = 0.045). Moreover, in the hollow viscus perforation group inter-hospital transfer was a predictor for reduced hospital length of stay (RC -10.02, 95%CI -18.14/-1.90, p = 0.016) and reduced severe complications (OR 0.38, 95%CI 0.18-0.77, p = 0.008). CONCLUSION Other than in patients with low surgical stress or hollow viscus perforation, in patients with potential bowel ischemia inter-hospital transfer was an independent predictor for higher mortality. Taking into account the time sensitiveness of bowel ischemia, efforts should be made to avoid inter-hospital transfer in this vulnerable subgroup of patients.
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Hinchcliffe Z, Mohamed I, Lala A. Day case laparoscopic cholecystectomy: Identifying patients for a 'COVID-Cold' isolated day-case unit during the pandemic. J Perioper Pract 2021; 31:62-70. [PMID: 33544661 DOI: 10.1177/1750458920977418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as 'COVID-cold' operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. METHOD Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. RESULTS The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age (p = 0.004), BMI (p = 0.01), ASA Score (p = 0.006), previous ERCP (p = 0.05), imaging suggesting cholecystitis (p = 0.003) and thick-walled gallbladder (p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05-3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72-11.38; p = 0.002) and previous ERCP (5.25, 1.53-18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35-39.9kg/m2. CONCLUSIONS Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35-39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.
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Affiliation(s)
- Zoe Hinchcliffe
- Department of General Surgery, 97671Ysbyty Gwynedd, Bangor, Wales, UK
| | - Imran Mohamed
- Department of General Surgery, 97671Ysbyty Gwynedd, Bangor, Wales, UK
| | - Anil Lala
- Department of General Surgery, 97671Ysbyty Gwynedd, Bangor, Wales, UK
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