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

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Abstract

Introduction

Early laparoscopic cholecystectomy (ELC) has shown to reduce length of stay and improve patients’ satisfaction as compared to delayed laparoscopic cholecystectomy (DLC). However, logistics and manpower limitations often preclude ELC.

Methods

A retrospective study was conducted in a single institute to compare outcomes of AC before (August 2013–2014) and after (August 2017–2018) establishment of emergency surgery and trauma (ESAT).

Results

There were 82 patients in pre-ESAT period and 172 patients in ESAT period. Mean age was 52.3 ± 11.6 and 55.7 ± 13.8 years, respectively, p = 0.369. There were more patients with moderate–severe grading of cholecystitis based on Tokyo Guidelines (TG 18) in ESAT 143/172 (83.1%) as compared to pre-ESAT 65/82 (79.3%), p = 0.042. Index cholecystectomy was performed in 145/172 (84.3%) of patients in the ESAT vs 34/82 (41.5%) of patients in the pre-ESAT period (p = 0.001). Time interval between booking to surgery was 180 ± 56 min in ESAT vs 197 ± 98 min in pre-ESAT, p = 0.014. Operative duration was shorter in ESAT 121 ± 38.5 min vs 139 ± 53.4, in pre-ESAT period, p = 0.030. Conversion rates were lower in ESAT (4/172, 2.3%) vs (9/72, 11%) in pre-ESAT, p = 0.003. Length of stay was shorter in ESAT (DLC 1.89 ± 1.6 and ELC ± 2.9 days) as compared to pre-ESAT (DLC 4.55 ± 2.2 and ELC 5.03 ± 2.6 days), p = 0.001. 30-day readmissions were lower in ESAT (3/172, 1.7%) vs pre-ESAT (8/72, 9.8%).

Conclusion

The ESAT model provided more early laparoscopic cholecystectomies with improved efficiency and clinical outcomes.

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Acknowledgements

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. Goh, Dr. Chia, Mr. Ong, Mr. Quek, Ms. Lim, Dr. Tan and Dr. Goo. The drafts of the manuscript were written by Dr. Goh, Dr. Chia, Mr. Ong, Mr. Quek, Ms. Lim, Dr. Tan and Dr. Goo. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore

    Si Ning Serene Goh, Clement Luck Khng Chia, Woan Wui Lim, Kok Yang Tan & Jerry Tiong Thye Goo

  2. National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore

    Jing Wen Ong & John Jian Xian Quek

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  1. Si Ning Serene Goh
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  2. Clement Luck Khng Chia
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Correspondence to Si Ning Serene Goh.

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Dr. Goh, Dr. Chia, Mr. Ong, Mr. Quek, Ms. Lim, Dr. Tan and Dr. Goo declare they have no conflict of interest.

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The corresponding author is not a recipient of any research scholarship.

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Goh, S.S., Chia, C.L.K., Ong, J.W. et al. Improved outcomes for index cholecystectomy for acute cholecystitis following a dedicated emergency surgery and trauma service (ESAT). Eur J Trauma Emerg Surg 47, 1535–1541 (2021). https://doi.org/10.1007/s00068-020-01308-1

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  • DOI: https://doi.org/10.1007/s00068-020-01308-1

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