Purpose Emergency general surgery patients undergoing laparoscopic surgery are at reduced risk of mortality and may require reduced length of critical care stay. This study investigated the effect of laparoscopy on high-risk patients’ post-operative care requirements. Methods Data were retrieved for all patients entered into the NELA database between 2013 and 2018. Only high-risk surgical patients (P-POSSUM predicted mortality risk of ≥ 5%) were included. Patients undergoing laparoscopic and open emergency general surgical procedures were compared using a propensity score weighting approach. Outcome measures included total length of critical care (level 3) stay, overall length of stay and inpatient mortality. Results A total of 66,517 high-risk patients received emergency major abdominal surgery. A laparoscopic procedure was attempted in 6998 (10.5%); of these, the procedure was competed laparoscopically in 3492 (49.9%) and converted to open in 3506 (50.1%). Following inverse probability treatment weighting adjustment for patient disease and treatment characteristics, high-risk patients undergoing laparoscopic surgery had a shorter median ICU stay (1 day vs 2 days p < 0.001), overall hospital length of stay (11 days vs 14 days p < 0.001) and a lower inpatient mortality (16.0% vs 18.8%, p < 0.001). They were also less likely to have a prolonged ICU stay with an OR of 0.78 (95% CI 0.74–0.83, p < 0.001). Conclusion The results of this study suggest that in patients at high risk of post-operative mortality, laparoscopic emergency bowel surgery leads to a reduced length of critical care stay, overall length of stay and inpatient mortality compared to traditional laparotomy.
Background On-table Cholangiography (OTC) is an important diagnostic tool in biliary surgery, allowing for assessment of biliary duct patency. However, debate remains over its overall benefit and safety vs peri-operative imaging. Research into the radiation exposure to both patients and surgeons and its subsequent risks remains minimal. Aim The aim of this retrospective study was to assess the average radiological dosage exposure as well as total exposure time for on-table Cholangiograms performed during Laparoscopic Cholecystectomies. We also aimed to assess for any clear difference in dosage and time exposure between different levels of trainee surgeons and consultants. Results A total of 157 OTCs were identified over a 12-month period; 57% performed by consultants (n=91), 23% by senior trainees’ level ST6-ST8 (n=36) and 29% by trainees level ST3-ST5 (n=36). The median radiological exposure time for all cases was 27 seconds, while median dosage/area exposure was 54.84 (uGy*m2). There were no significant differences in mean and median results between the different training levels of the performing surgeon. Conclusions Average radiological exposure dosage/area and time was consistent throughout the different groups of surgeons. While the exposure appears to remain at relatively low levels, further research into the risk of exposure during OTCs is needed to provide guidance to surgeons performing such procedures.
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