Skip to main content

Advertisement

SpringerLink
Log in

Emergency Management of Gallbladder Disease: Are Acute Surgical Units the New Gold Standard?

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Since 2011, all acute general surgical admissions have been managed by the consultant-led emergency general surgery service (EGS) at our institution. We aim to compare EGS management of acute biliary disease to its preceding model.

Materials and methods

Retrospective review of prospectively collated databases was performed to capture consecutive emergency admissions with biliary disease from 1st February 2009 to 31st January 2013. Patient demographics, surgical intervention, use of diagnostic radiology, histological diagnosis, complications and hospital length of stay (LOS) were retrieved.

Results

A total of 566 patients were included (pre-EGS 254 vs. EGS 312). In the EGS period, the number of patients having surgery on index admission increased from 43.7 to 58.7 % (p < 0.001) as did use of intra-operative cholangiography from 75.7 to 89.6 % (p = 0.003). The conversion to open cholecystectomy rate also was reduced from 14.4 to 3.3 % (p < 0.001). Overall, a 14 % reduction in use of multiple (>1) imaging modalities for diagnosis was noted (p = 0.003). There was a positive trend in reduction of bile leaks but no significant difference in the overall morbidity and mortality. Time to theatre was reduced by 1 day [pre-EGS 2.7 (IQR 1.5–5.0) vs. EGS 1.7 (IQR 1.2–2.6) p < 0.001]. The overall hospital LOS was reduced by 1.5 days [pre-EGS 5.0 (IQR 3–7) vs. EGS 3.5 (IQR 2–5) p < 0.001].

Conclusion

Since the advent of EGS, more judicious use of diagnostic radiology, reduced complications, reduced LOS, reduced time to theatre and an increased rate of definitive management during the index admission were demonstrated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stinton LM, Shaffer EA (2012) Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 6:172–187

    Article  PubMed Central  PubMed  Google Scholar 

  2. Gale SC, Shafi S, Dombrovskiy VY et al (2014) The public health burden of emergency general surgery in the United States. J Trauma Acute Care Surg 77:202–208

    Article  PubMed  Google Scholar 

  3. Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV (2013) Acute care surgery: now that we have built it, will they come? J Trauma Acute Care Surg 74:463–468 discussion 8–9

    Article  PubMed  Google Scholar 

  4. Hsee L, Devaud M, Civil I (2012) Key performance indicators in an acute surgical unit: Have we made an impact? World J Surg 36:2335–2340. doi:10.1007/s00268-012-1670-5

    Article  PubMed  Google Scholar 

  5. Boyle E, McCormack H, O’Rourke A et al (2012) Improving patient care—the first year in a dedicated surgical assessment unit. Ir Med J 105:233–236

    CAS  PubMed  Google Scholar 

  6. Ball CG, Hameed SM, Brenneman FD (2010) Acute care surgery: a new strategy for the general surgery patients left behind. Can J Surg 53:84–85

    PubMed Central  PubMed  Google Scholar 

  7. Hameed SM, Brenneman FD, Ball CG et al (2010) General surgery 2.0: the emergence of acute care surgery in Canada. Can J Surg 53:79–83

    PubMed Central  PubMed  Google Scholar 

  8. O’Mara MS, Scherer L, Wisner D, Owens LJ (2014) Sustainability and success of the acute care surgery model in the nontrauma setting. J Am Coll Surg 219:90–98

    Article  PubMed  Google Scholar 

  9. Cubas RF, Gómez NR, Rodriguez S et al (2012) Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost. J Am Coll Surg 215:715–721

    Article  PubMed  Google Scholar 

  10. Pepingco L, Eslick GD, Cox MR (2012) The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis. Med J Aust 196:509–510

    Article  PubMed  Google Scholar 

  11. Lehane CW, Jootun RN, Bennett M et al (2010) Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J Surg 80:438–442

    Article  PubMed  Google Scholar 

  12. Britt RC, Bouchard C, Weireter LJ, Britt LD (2010) Impact of acute care surgery on biliary disease. J Am Coll Surg 210:595–601

    Article  PubMed  Google Scholar 

  13. Yamashita Y, Takada T, Kawarada Y et al (2007) Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepato-biliary-pancreat Surg 14:91–97

    Article  Google Scholar 

  14. Nagaraja V, Eslick GD, Cox MR (2014) The acute surgical unit model verses the traditional “on call” model: a systematic review and meta-analysis. World J Surg 38:1381–1387. doi:10.1007/s00268-013-2447-1

    Article  PubMed  Google Scholar 

  15. Suen K, Hayes IP, Thomson BNJ, Shedda S (2014) Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy. Br J Surg 101:e141–e146

    Article  CAS  PubMed  Google Scholar 

  16. Brockman SF, Scott S, Guest GD et al (2013) Does an Acute Surgical Model increase the rate of negative appendicectomy or perforated appendicitis? ANZ J Surg 83:744–747

    PubMed  Google Scholar 

  17. Pillai S, Hsee L, Pun A et al (2013) Comparison of appendicectomy outcomes: acute surgical versus traditional pathway. ANZ J Surg 83:739–743

    PubMed  Google Scholar 

  18. Poh BR, Cashin P, Dubrava Z et al (2013) Impact of an acute care surgery model on appendicectomy outcomes. ANZ J Surg 83:735–738

    PubMed  Google Scholar 

  19. Gandy RC, Truskett PG, Wong SW et al (2010) Outcomes of appendicectomy in an acute care surgery model. Med J Aust 193:281–284

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 2 East, 300 Grattan St, Parkville, VIC, 3050, Australia

    Rose Shakerian, Anita Skandarajah & Benjamin Thomson

  2. Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Level 6, Clinical Sciences Building, 300 Grattan St, Parkville, VIC, 3050, Australia

    Rose Shakerian, Anita Skandarajah & Benjamin Thomson

  3. Melbourne EpiCentre, Centre for Clinical Epidemiology, Biostatistics and Health Services Research, The Royal Melbourne Hospital, University of Melbourne and Melbourne Health, 7 East, Main Building, Grattan Street, Parkville, VIC, 3050, Australia

    Alexandra Gorelik

Authors
  1. Rose Shakerian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anita Skandarajah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandra Gorelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rose Shakerian.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shakerian, R., Skandarajah, A., Gorelik, A. et al. Emergency Management of Gallbladder Disease: Are Acute Surgical Units the New Gold Standard?. World J Surg 39, 2636–2640 (2015). https://doi.org/10.1007/s00268-015-3196-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3196-0

Keywords

Search

Navigation