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Purpose The Tokyo Guidelines 2018 (TG18) were developed to aid diagnosis and treatment for acute cholecystitis. The benefits of being treated in an acute general surgical unit (AGSU) include earlier diagnosis and treatment. This study aims to define the usefulness of TG18 before and after the introduction of AGSU. Methodology Patients who underwent cholecystectomy at Northern Health were audited retrospectively and assessed for TG18 diagnostic criteria and outcomes between 1 February 2012 and 1 February 2014 (one-year pre-and post-AGSU).Results Five hundred and eighty-seven patients underwent emergency cholecystectomy with 203 (34.6%) patients having a suspected diagnosis, and 234 (39.9%) patients with a definitive diagnosis of acute cholecystitis using TG18 diagnostic criteria. After the introduction of AGSU, time from imaging to operation improved from 2.5 to 1.7 days (p = 0.012). There were more operations occurring during in-hours following AGSU implementation (75.8% vs. 62.7%, p \ 0.001). Maximum pre-operative CRP of [26.6 mg/L had a higher likelihood of Clavien-Dindo complication grade 3 or 4 (OR 3.86, 95%CI 1.18-12.63, p = 0.027) compared with TG18 definitive diagnosis criteria (OR 1.50, 95%CI 0.46-4.91, p = 0.501). Surprisingly, there was a trend towards higher complications and readmissions for patients operated within 24 h, although this trend was not significant. Conclusion Patients with suspected acute cholecystitis should be stratified clinically and with CRP in an AGSU with TG18 adding little value in a busy metropolitan unit.
We describe a safe technique for controlled deflation of pneumoperitoneum to facilitate safe laparoscopic surgery in the coronavirus disease 2019 (COVID‐19) era.
Backgrounds
This study aims to identify the objective findings of haemoglobin (Hb) drift in patients that had a Whipple's procedure in the last 10 years, their transfusion status intraoperatively and post‐operatively, the potential factors affecting Hb drift, and the outcomes following Hb drift.
Methods
A retrospective study was conducted at Northern Health, Melbourne. All adult patients who were admitted for a Whipple's procedure from 2010 to 2020 were included and information collected retrospectively for demographics, pre‐operative, operative and post‐operative details.
Results
A total of 103 patients were identified. The median Hb drift calculated from a Hb level at the end of operation was 27.0 g/L (IQR 18.0–34.0), and 21.4% of patients received a packed red blood cell (PRBC) transfusion during the post‐operative period. Patients received a large amount of intraoperative fluid with a median of 4500 mL (IQR 3400‐5600). Hb drift was statistically associated with intraoperative and post‐operative fluid infusion leading to concurrent issues with electrolyte imbalance and diuresis.
Conclusion
Hb drift is a phenomenon that does happen in major operations such as a Whipple's procedure, likely secondary to fluid over‐resuscitation. Considering the risk of fluid overload and blood transfusion, Hb drift in the setting of fluid over‐resuscitation needs to be kept in mind prior to blood transfusion to avoid unnecessary complications and wasting of other precious resources.
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