Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

Abstract

INTRODUCTION Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. METHODS The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. RESULTS The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to 'surgeon preference/skill', was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. CONCLUSIONS A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis

“…Figure 1 shows the modified PRISMA flowchart for identification and inclusion of relevant papers. Twentythree studies were excluded from the meta-analysis; 10 papers were deemed low quality [53][54][55][56][57][58][59][60][61] and 13 papers did not provide readmission rates specific to LC [62][63][64][65][66][67][68][69][70][71][72][73][74].…”

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

“…There is good evidence that dedicated EGS surgeons can improve a variety of outcomes for patients with appendicitis [11,12] and gallstone disease [12][13][14][15]. However, a number of papers in the literature express concern about the outcomes of more specialized procedures, particularly colorectal resection [16][17][18][19][20][21] and gastrectomy [22].…”

Early Laparoscopic Cholecystectomy in acute cholecystitis and its sequlae: Experience in tertiary care hospital

“…But the exact time point of ELC in AC is still a matter of debate. Tokyo Guidelines 2013 preferred to perform LC within 72 hours of symptom onset 6 , whereas NICE recommended LC in AC within 7 days of diagnosis 7 . Till now there is no published document on LC beyond 7 days of onset of AC.…”

“…pancreatic surgery suggested that emergency cholecystectomy was indicated for patients with symptoms within 72 hours while that of the national institute for health and care excellence (NICE) recommended that AC should be treated within seven days of diagnosis 7 .…”