Yuchen Luo1, Marang Makepe2, Arthur Yim2, Mark Tacey2,3, David Bird2, Russell Hodgson2,4. 1. Northern Health, 185 Cooper Street, Epping, VIC, 3076, Australia. lyc_jtvc@me.com. 2. Northern Health, 185 Cooper Street, Epping, VIC, 3076, Australia. 3. Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3052, Australia. 4. University of Melbourne, 185 Cooper Street, Epping, VIC, 3076, Australia.
Abstract
PURPOSE: The Tokyo Guidelines 2018 (TG18) were developed to aid diagnosis and treatment for acute cholecystitis. The benefits of being treated in an acute general surgical unit (AGSU) include earlier diagnosis and treatment. This study aims to define the usefulness of TG18 before and after the introduction of AGSU. METHODOLOGY: Patients who underwent cholecystectomy at Northern Health were audited retrospectively and assessed for TG18 diagnostic criteria and outcomes between 1 February 2012 and 1 February 2014 (one-year pre- and post-AGSU). RESULTS: Five hundred and eighty-seven patients underwent emergency cholecystectomy with 203 (34.6%) patients having a suspected diagnosis, and 234 (39.9%) patients with a definitive diagnosis of acute cholecystitis using TG18 diagnostic criteria. After the introduction of AGSU, time from imaging to operation improved from 2.5 to 1.7 days (p = 0.012). There were more operations occurring during in-hours following AGSU implementation (75.8% vs. 62.7%, p < 0.001). Maximum pre-operative CRP of >26.6 mg/L had a higher likelihood of Clavien-Dindo complication grade 3 or 4 (OR 3.86, 95%CI 1.18-12.63, p = 0.027) compared with TG18 definitive diagnosis criteria (OR 1.50, 95%CI 0.46-4.91, p = 0.501). Surprisingly, there was a trend towards higher complications and readmissions for patients operated within 24 h, although this trend was not significant. CONCLUSION: Patients with suspected acute cholecystitis should be stratified clinically and with CRP in an AGSU with TG18 adding little value in a busy metropolitan unit.
PURPOSE: The Tokyo Guidelines 2018 (TG18) were developed to aid diagnosis and treatment for acute cholecystitis. The benefits of being treated in an acute general surgical unit (AGSU) include earlier diagnosis and treatment. This study aims to define the usefulness of TG18 before and after the introduction of AGSU. METHODOLOGY:Patients who underwent cholecystectomy at Northern Health were audited retrospectively and assessed for TG18 diagnostic criteria and outcomes between 1 February 2012 and 1 February 2014 (one-year pre- and post-AGSU). RESULTS: Five hundred and eighty-seven patients underwent emergency cholecystectomy with 203 (34.6%) patients having a suspected diagnosis, and 234 (39.9%) patients with a definitive diagnosis of acute cholecystitis using TG18 diagnostic criteria. After the introduction of AGSU, time from imaging to operation improved from 2.5 to 1.7 days (p = 0.012). There were more operations occurring during in-hours following AGSU implementation (75.8% vs. 62.7%, p < 0.001). Maximum pre-operative CRP of >26.6 mg/L had a higher likelihood of Clavien-Dindo complication grade 3 or 4 (OR 3.86, 95%CI 1.18-12.63, p = 0.027) compared with TG18 definitive diagnosis criteria (OR 1.50, 95%CI 0.46-4.91, p = 0.501). Surprisingly, there was a trend towards higher complications and readmissions for patients operated within 24 h, although this trend was not significant. CONCLUSION:Patients with suspected acute cholecystitis should be stratified clinically and with CRP in an AGSU with TG18 adding little value in a busy metropolitan unit.
Authors: G Paul Wright; Kellen Stilwell; Jared Johnson; Matthew T Hefty; Mathew H Chung Journal: J Hepatobiliary Pancreat Sci Date: 2015-09-15 Impact factor: 7.027
Authors: Robert C Gandy; Phillip G Truskett; Shing W Wong; Sanchia Smith; Michael H Bennett; Andrew D Parasyn Journal: Med J Aust Date: 2010-09-06 Impact factor: 7.738
Authors: Stefan Jansen; Maciej Stodolski; Hubert Zirngibl; Daniel Gödde; Peter C Ambe Journal: World J Emerg Surg Date: 2018-02-20 Impact factor: 5.469