Optimising the outcomes of index admission laparoscopic cholecystectomy and bile duct exploration for biliary emergencie
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and Other Interventional Techniques
Optimising the outcomes of index admission laparoscopic cholecystectomy and bile duct exploration for biliary emergencies: a service model Ahmad H. M. Nassar1 · Hwei J. Ng2 · Zubir Ahmed2 · Arkadiusz Peter Wysocki3 · Colin Wood2 · Ayman Abdellatif1 Received: 5 June 2020 / Accepted: 17 August 2020 © The Author(s) 2020
Abstract Aims The rate of acute laparoscopic cholecystectomy remains low due to operational constraints. The purpose of this study is to evaluate a service model of index admission cholecystectomy with referral protocols, refined logistics and targeted job planning. Methods A prospectively maintained dataset was evaluated to determine the processes of care and outcomes of patients undergoing emergency biliary surgery. The lead author has maintained a 28 years prospective database capturing standard demographic data, intraoperative details including the difficulty of cholecystectomy as well as postoperative outcome parameters and follow up data. Results Over five thousand (5555) consecutive laparoscopic cholecystectomies were performed. Only patients undergoing emergency procedures (2399,43.2% of entire group) were analysed for this study. The median age was 52 years with 70% being female. The majority were admitted with biliary pain (34%), obstructive jaundice (26%) and acute cholecystitis (16%). 63% were referred by other surgeons. 80% underwent surgery within 5 days (40% within 24 h). Cholecystectomies were performed on scheduled lists (44%) or dedicated emergency lists (29%). Two thirds had suspected bile duct stones and 38.1% underwent bile duct exploration. The median operating time was 75 min, median hospital stay 7 days, conversion rate 0.8%, morbidity 8.9% and mortality rate 0.2%. Conclusion Index admission cholecystectomy for biliary emergencies can have low rates of morbidity and mortality. Timely referral and flexible theatre lists facilitate the service, optimising clinical results, number of biliary episodes, hospital stay and presentation to resolution intervals. Cost benefits and reduced interval readmissions need to be weighed against the length of hospital stay per episode. Keywords Laparoscopic cholecystectomy · Emergency surgery · Biliary emergencies · Gall stones · Index admission surgery · Difficulty grading · Nassar Scale Gallstone related admissions represent nearly one third of emergency general surgery admissions in the United Kingdom—e.g. 15,000 in England in 2013–2014 [1]. Urgent cholecystectomy rates (within 10 days of first admission) for acute cholecystitis range from 0.2 to 35% across England * Ahmad H. M. Nassar [email protected]; [email protected] 1
Laparoscopic Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK
2
NHS Greater Glasgow and Clyde, Glasgow, UK
3
Logan Hospital, Corner Meadowbrook and Loganlea Roads, Meadowbrook, QLD 4133, Australia
[2]. Sinha et al. [3] and Harrison et al. [4] reported wide variations in the management and outcomes of cholecystectomy in England and
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