Improved outcomes for index cholecystectomy for acute cholecystitis following a dedicated emergency surgery and trauma service (ESAT)

Goh, Si Ning Serene; Chia, Clement Luck Khng; Ong, John; Quek, John Jian Xian; Lim, Woan Wui; Tan, Kok‐Yang; Goo, Jerry Tiong Thye

doi:10.1007/s00068-020-01308-1

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…As far as our study is concerned, the underlying comorbid diseases of the subjects were established as diabetes (23.9%) and hypertension (6.5%), and the mean blood cholesterol level was calculated as 141.14 mg/dl (± 31.33). In addition, while Goh et al [11] report that 12.2% of their patients diagnosed with AC were also afflicted with ischemic heart disease, this rate was found as 21.7% in our study. The presence of comorbid diseases reinforces the need for emergency surgery in patients admitted with abdominal pain complaints and diagnosed with cholecystitis, and a lower total cholesterol level may account for the low rate of acute calculous cholecystitis.…”

Section: Discussioncontrasting

confidence: 62%

Does the Frequency of Acute Cholecystitis Decrease During the Ramadan Month?

Seyit

Yılmaz

et al. 2021

International Journal of Health Services Research and Policy

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The pathophysiological mechanism of acute cholecystitis (AC), which is essentially the inflammation of the gallbladder, is blockage of the cystic duct, and its most common cause is gallstones. On the other hand, fasting held in Ramadan is worship practiced by Muslims within the period from dawn to sunset by avoiding any eating and drinking act. Within this framework, our study ultimately intends to reveal the variation of AC in two different time periods. We retrospectively compared the demographic characteristics, admittance times, biochemical parameters of the subjects diagnosed with AC and hospitalized in the general surgery between 2012 and 2018. We also evaluated diagnosis classification, length of hospitalization, presence of intensive care stay, presence of operation during hospitalization, and the underlying comorbid diseases of the subjects. 225 patients were hospitalized in the general surgery service after being diagnosed with AC in the ED over the course of six years, yet the total number of subjects recruited for the study is 46. Whereas 10 patients (21.7%) were admitted and hospitalized during the Ramadan month, 36 (78.3%) patients in the other group were hospitalized one month before and after Ramadan. 16 (34.8%) of the hospitalized patients underwent emergency surgery, while 30 (65.2%) patients were operated on electively. The comparison of the two cohorts in our study revealed no significant difference in relation to the demographic characteristics, laboratory findings, imaging methods, underlying comorbid diseases, and the length of hospital stay. Nevertheless, clinical investigations seem to have revealed a difference between groups.

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Section: Discussioncontrasting

confidence: 62%

Does the Frequency of Acute Cholecystitis Decrease During the Ramadan Month?

Seyit

Yılmaz

et al. 2021

International Journal of Health Services Research and Policy

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“…The application of acute care service in several centers has shown improvement in productivity and outcomes in patients with cholecystitis and appendicitis. [1][2][3] Similarly, the Emergency Surgery and Trauma (ESAT) model in our experience has been shown to provide more early laparoscopic cholecystectomies with improved efficiency and clinical outcomes, 4 but the outcome in patients with appendicitis has not been studied yet.…”

Section: Introductionmentioning

confidence: 99%

Impact of a dedicated emergency surgical service on appendicitis outcomes

Goh

Cheok

Lim

et al. 2020

Acute Medicine & Surgery

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Aim: The Emergency Surgery and Trauma (ESAT) team is a dedicated consultant-led service to streamline the emergency surgical workload in Singapore. As acute appendicitis is one of the most common acute surgical conditions, we aim to compare outcomes of patients with appendicitis in the ESAT model as compared to the traditional on-call model. Methods: A retrospective review of patients admitted to Khoo Teck Puat Hospital, Singapore, with acute appendicitis between two periods: May-October 2014 (6 months pre-ESAT) versus January-June 2017 (post-ESAT). Patient demographics, operative details, efficiency, clinical outcomes, and hospital bill savings were evaluated. Results: There were 192 patients in the pre-ESAT period and 179 patients in the post-ESAT period. Patient demographics and comorbidities were comparable (P > 0.05). Time from emergency department referral to surgical review was significantly reduced in the ESAT period: 77.8 AE 46.9 min versus 127 AE 102 in the pre-ESAT period (P = 0.002). Time from case booking to operating theatre was significantly shorter in the ESAT period: 72.4 AE 55.2 min compared to 157.3 AE 209.1 (P < 0.01). More cases were carried out in the daytime during the ESAT period, 50.2% versus 39.1% (P = 0.029). The majority underwent laparoscopic appendectomy 156/179 (87.2%) in the ESAT period, with fewer open appendectomies 3/179 (1.7%) as compared to the pre-ESAT period (P = 0.062). There were higher intraoperative consultant supervision rates during the ESAT period, 38/166 (22.9%) as compared to 12/166 (6.7%) in the pre-ESAT period (P = 0.001). There were fewer complications (Clavien-Dindo grade II and above) in the ESAT period, 1 (0.6%) as compared to 6 (3.4%) pre-ESAT (P = 0.07). Conclusion: The ESAT service is associated with better efficiency outcomes for patients with acute appendicitis.

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