Chad Hall1, Justin L Regner1, Thomas Schroeppel2, Joe Rodriguez2, Robert McIntyre3, Franklin Wright3, Sharmila Dissanaike4, Robyn Richmond4, Ariel Santos4, Richard C Frazee5. 1. Baylor Scott & White Health, Department of Surgery, Temple, TX, USA. 2. UCHealth, Department of Surgery, Colorado Springs, CO, USA. 3. University of Colorado, Department of Surgery, Denver, CO, USA. 4. Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA. 5. Baylor Scott & White Health, Department of Surgery, Temple, TX, USA. Electronic address: Richard.frazee@bswhealth.org.
Abstract
BACKGROUND: Several options exist for the diagnosis and management of suspected common duct stones. We hypothesized that a protocol-directed approach would shorten length of stay in this patient population. METHODS: Patients from four participating institutions with a peak bilirubin <4 mg/dL underwent surgery as the initial procedure, whereas patients with a bilirubin ≥4 mg/dL underwent endoscopy. The primary endpoint was length of stay. Analysis involved chi square and Wilcoxon-Mann-Whitney test with significance at p < 0.05. RESULTS: 214 patients were managed under the protocol during six-month study period. 111 patients (52%) required endoscopy and surgery. Length of stay and the number of MRCPs performed pre-operatively significantly decreased following protocol implementation (p < 0.05). CONCLUSIONS: "Surgery first" approach in patients with bilirubin <4 ml/dL resulted in low morbidity and mortality, reduced MRCP, and length of stay.
BACKGROUND: Several options exist for the diagnosis and management of suspected common duct stones. We hypothesized that a protocol-directed approach would shorten length of stay in this patient population. METHODS:Patients from four participating institutions with a peak bilirubin <4 mg/dL underwent surgery as the initial procedure, whereas patients with a bilirubin ≥4 mg/dL underwent endoscopy. The primary endpoint was length of stay. Analysis involved chi square and Wilcoxon-Mann-Whitney test with significance at p < 0.05. RESULTS: 214 patients were managed under the protocol during six-month study period. 111 patients (52%) required endoscopy and surgery. Length of stay and the number of MRCPs performed pre-operatively significantly decreased following protocol implementation (p < 0.05). CONCLUSIONS: "Surgery first" approach in patients with bilirubin <4 ml/dL resulted in low morbidity and mortality, reduced MRCP, and length of stay.