Economic Implications of Providing Emergency Cholecystectomy for All Patients With Biliary Pathology

Seager, Alexander; Hall, Thomas C.; Dennison, Ashley R.; Garcea, Giuseppe

doi:10.1097/sle.0000000000000169

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…The principal studies comparing index admission and elective cholecystectomy in patients admitted with biliary pathology do not acknowledge readmission morbidity before the operation and its impact on overall outcome [10][11][12][13][14][15][16][17][18]. This study demonstrates that the morbidity associated with readmission in BC patients is more severe than the difference in morbidity between index and elective cholecystectomy and cannot be disregarded.…”

Section: Discussionmentioning

confidence: 98%

“…Therefore, index admission surgery must be advocated as a cost-effective strategy for BC patients as this will reduce readmissions, overall morbidity and waiting times. This issue is ever more pertinent in the light of the COVID-19 pandemic which has resulted in increasing waiting list times and the further exposure to the risk of readmission [18,[22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Although the outcomes of index admission versus elective LC for biliary pathology have been compared, the literature mainly focuses on the optimal timing of cholecystectomy for acute cholecystitis. The risks and consequences of readmission before elective LC in patients admitted with BC has not yet been investigated [10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Index Admission Cholecystectomy for Biliary Colic Precludes the Risk of Readmissions with Biliary Complications and should be Standard Treatment

2022

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Background Emergency biliary colic admissions can be managed with an index or elective laparoscopic cholecystectomy (LC). Opting to perform an elective LC may have significant repercussions such as the risk of readmissions before operation with further attacks or with biliary complications (e.g. cholecystitis, pancreatitis, choledocholithiasis). The risk of readmission and biliary complications in patients admitted with biliary colic but scheduled for elective surgery has never been investigated. The secondary aim was to compare rates of peri-operative morbidity between the index admission, elective and readmission LC cohorts. Method All patients admitted with a diagnosis of biliary colic over a 5-year period and proceeding to LC were included in the study (n = 441). The risk of being readmitted and suffering further morbidity whilst awaiting elective LC was investigated. Peri-operative morbidity was compared between the index admission, elective and readmitted LC groups using univariate and multivariate analysis. Results Following a biliary colic admission, the risk of readmission whilst awaiting elective LC is significant (2 months-25%; 10 months-48%). In this group, the risks of subsequent biliary complications (18.0%) and the requirement for ERCP (6.5%) were significant. Patients who are readmitted before LC, suffer a more complicated peri-operative course (longer total length of stay, higher post-operative complications, imaging and readmission). Discussion Index admission LC for biliary colic avoids the significant risk of readmission and biliary complications before surgery and should be the gold standard. Readmitted patients are likely to have higher rates of peri-operative adverse outcomes. Patients should be counselled about these risks.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Index Admission Cholecystectomy for Biliary Colic Precludes the Risk of Readmissions with Biliary Complications and should be Standard Treatment

2022

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“…26 A review of 84 patients over a 12-month period from a single centre in the UK identified savings of £695 918 through implementation of early cholecystectomy. 27 Data from the United States show that patients presenting to ED with acute biliary pain and then discharged on a pathway for elective cholecystectomy have a 20% chance of representing within 30 days. What is also not captured is the rate of presentations to general practitioners with biliary type pain and the time and resources lost to the community by these visits.…”

Section: Discussionmentioning

confidence: 99%

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

Cox

Fong

Liew

et al. 2018

ANZ Journal of Surgery

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Background: Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic in a tertiary hospital in Australia. Methods: This is a retrospective cohort study of adult patients presenting to the emergency department (ED) with biliary pain during three 12-month periods. Outcomes in Group A, 3 years prior to policy implementation, were compared with groups 2 and 7 years post implementation (Groups B and C). Primary outcomes were representations to ED, admission rate and time to cholecystectomy. Results: A total of 584 patients presented with biliary colic during the three study periods. Of these, 391 underwent cholecystectomy with three Strasberg Type A bile leaks and no bile duct injuries. The policy increased admission rates (A = 15.8%, B = 62.9%, C = 29.5%, P < 0.001) and surgery on index presentation (A = 12.0%, B = 60.7%, C = 27.4%, P < 0.001). There was a decline in time to cholecystectomy (days) (A = 143, B = 15, C = 31, P < 0.001), post-operative length of stay (days) (A = 3.6, B = 3.2, C = 2.0, P < 0.05) and representation rates to ED (A = 42.1%, B = 7.1%, C = 19.9%, P < 0.001). There was a decline in policy adherence in the later cohort. Conclusion: Index hospital admission and cholecystectomy for biliary colic decrease patient representations, time to surgery, post-operative stay and complications of gallstone disease. This study demonstrates the impact of the policy with initial improvement, the dangers of policy attrition and the need for continued reinforcement.

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“…Laparoscopic cholecystectomy undertaken during the index admission is the standard of care for patients with acute cholecystitis and also for those with mild or moderate acute biliary pancreatitis (1)(2)(3). Index-admission management of symptomatic gallstone disease prevents recurrent biliary events and reduces healthcare costs (4,5). For such a strategy to be feasible, the necessary surgical expertise must be available to provide this level of care.…”

Section: Introductionmentioning

confidence: 99%

The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

et al. 2021

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Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

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Economic Implications of Providing Emergency Cholecystectomy for All Patients With Biliary Pathology

Abstract: ALC is cost-effective and safe. It can be offered to all patients with biliary pathology provided they are fit enough for surgery.

Cited by 4 publications

References 22 publications

Index Admission Cholecystectomy for Biliary Colic Precludes the Risk of Readmissions with Biliary Complications and should be Standard Treatment

Index Admission Cholecystectomy for Biliary Colic Precludes the Risk of Readmissions with Biliary Complications and should be Standard Treatment

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

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