Rose Shakerian1,2, Anita Skandarajah3,4, Alexandra Gorelik5, Benjamin Thomson3,4. 1. Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 2 East, 300 Grattan St, Parkville, VIC, 3050, Australia. shakerian.rose@gmail.com. 2. Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Level 6, Clinical Sciences Building, 300 Grattan St, Parkville, VIC, 3050, Australia. shakerian.rose@gmail.com. 3. Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 2 East, 300 Grattan St, Parkville, VIC, 3050, Australia. 4. Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Level 6, Clinical Sciences Building, 300 Grattan St, Parkville, VIC, 3050, Australia. 5. 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.
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.
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.
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