scholarly journals 709 Covid-19 Pandemic: Audit on The Management of Acute Cholecystitis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Asarbakhsh ◽  
N Lazarus ◽  
P Lykoudis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Readmission Rate ◽  
Adverse Outcomes ◽  
Management Option ◽  
Management Guidelines ◽  
Theatre Staff ◽  
The Impact ◽  
Definitive Management ◽  
Upper Gastrointestinal

Abstract Background The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines. Method The audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included. Result 24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis. Conclusions 19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.

The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis

1999 ◽  
Vol 178 (4) ◽  
pp. 303-307 ◽  
Author(s):  
Samuel Eldar ◽  
Arie Eitan ◽  
Amitai Bickel ◽  
Edmond Sabo ◽  
Ayala Cohen ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Patient Delay ◽  
The Impact

Unusual fistula demonstrating the need for an early cholecystectomy

2020 ◽  
Vol 13 (9) ◽  
pp. e235795
Author(s):  
Gregory Harrison ◽  
Roland Fernandes
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Cholecystectomy ◽  
Calot’S Triangle ◽  
Initial Episode ◽  
Laparoscopic Assisted ◽  
Definitive Management ◽  
Active Disease

A 79-year-old man developed a spontaneous cholecystocutaneous fistula 12 months after an initial episode of acute cholecystitis. A laparoscopic cholecystectomy procedure was twice abandoned due to extensive adhesions and active disease, limiting safe dissection of Calot's triangle. Abdominal collections formed and a spontaneous cholecystocutaneous fistula developed. Imaging revealed an 11 cm calculus and erosion of the fundus of the gall bladder through the sheath. Definitive management was achieved with a laparoscopic assisted open cholecystectomy.

scholarly journals Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

2016 ◽  
Vol 98 (2) ◽  
pp. 107-115 ◽  
Author(s):  
S Bokhari ◽  
U Walsh ◽  
K Qurashi ◽  
L Liasis ◽  
J Watfah ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Best Practice ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Early Laparoscopic Cholecystectomy ◽  
Before And After ◽  
One Year ◽  
The Impact ◽  
Surgical Unit

Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to ‘surgeon preference/skill’, was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. Conclusions A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

Abstract WP390: Closing the Gap: Integrating Community Paramedics in Stroke Patients Transition to Home

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Susan J Ashcraft ◽  
Laura Post ◽  
Camron Young
Keyword(s):  
Readmission Rate ◽  
Transitional Care ◽  
Care Delivery ◽  
Care Program ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Population ◽  
The Impact

Background and Issues: The transition of stroke patients home is complex. Assessment of functional status and coordination of healthcare and support services while engaging patient and family to be active participants in secondary prevention is essential in preventing stroke recurrence. Readmission rates for stroke patients are also high. Reductions in stroke readmissions must target unresolved problems at discharge and the quality of immediate post-hospital care. Purpose: The purpose of the Community Paramedic program is to reduce stroke readmissions. An additional goal is to identify key areas which may contribute to poor patient outcomes or readmission and develop and implement action plans for their prevention. Methods: Use of a community paramedic transitional care model is an innovative approach to reduce readmissions in the stroke population. Using the Model for Improvement, an interprofessional team developed a transitional care program focusing on patient-centered care delivery, and on reducing readmissions and adverse outcomes. Use of The National Transitions of Care Coalition’s essential interventions categories, the program addressed: medication management, transitional planning, shared accountability, provider engagement, patient and family engagement and education, follow-up care, and information transfer. Results: Despite a 13% increase in stroke patient volume from 2014 to 2015, the program realized a statistically significant reduction in readmission rate (10.7% to 8.51%; p = .045, α =.05) in 2015 and has sustained the reduction through 2016. This reduction represents 21 avoided readmissions in the stroke population with cost avoidance of at least $210,000.00. The decrease in readmission rate is well below both the goal and stretch goals of 5% and 10% reduction in stroke readmissions. Conclusion: The impact of integrating Community Paramedics into a transitional care program coordinated through Stroke Navigators shows a significant impact on reducing 30-day readmissions. Replication in other patient populations and other counties may have a significant impact for both patients and hospitals focused on improving similar outcomes.

scholarly journals Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 230
Author(s):  
Dragos Serban ◽  
Bogdan Socea ◽  
Simona Andreea Balasescu ◽  
Cristinel Dumitru Badiu ◽  
Corneliu Tudor ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
The Elderly ◽  
Early Postoperative Period ◽  
Invasive Approach ◽  
Physical Status Classification ◽  
The Impact

Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50–64 years; C: 65–79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50–64 years, 65–79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.

scholarly journals Comparative analysis of management of acute cholecystitis during the SARS-CoV-2 coronavirus pandemic

MOJ Surgery ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 35-38
Author(s):  
Belén Matías-García ◽  
Ana Sánchez-Gollarte ◽  
Ana Quiroga-Valcárcel ◽  
Fernando Mendoza-Moreno ◽  
Javier Mínguez-García ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Comparative Analysis ◽  
Postoperative Complications ◽  
Observational Study ◽  
Acute Cholecystitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Number Of Patients ◽  
The World ◽  
The Mean ◽  
The Impact

Introduction: COVID-19 infection has spread throughout the world and is considered a pandemic. Since its appearance, the number of non-COVID-19 patients admitted to hospitals has decreased and patients differ care for emergency diseases. We analyze the impact of the SARS-CoV-2 coronavirus pandemic on the management of acute cholecystitis. Material and methods: Retrospective observational study that includes all patients diagnosed with acute cholecystitis during the SARS-CoV-2 coronavirus pandemic (period between March 11th and June 21st, 2020) and patients diagnosed with acute cholecystitis in the same period, the previous year in our center. Patient’s features, management, postoperative complications and mean hospital stay were compared. Results: In 2020, 19 patients with acute cholecystitis were diagnosed compared to 21 who were registered in the same period in 2019. The mean number of days from symptoms onset in 2020 was 2.42±1.8 days, while in 2019 it was 3.5±3.1 days (p=0.32). The percentage of cholecystectomies, percutaneous cholecystostomies and conservative management was similar in both periods. Among patients who underwent cholecystectomy in 2020, 37.5% had no complications, 62.5% had accidental opening of the gallbladder, and none had bleeding. Among patients who underwent cholecystectomy in 2019, 81.8% had no complications, 9.09% had accidental opening of the gallbladder, and 9.09% presented bleeding. The mean stay in 2020 was 4.21±3.2 days, compared to 8.57±7.4 days in 2019 (p=0.005). Two patients of 19 diagnosed with acute cholecystitis in 2020 had COVID-19 disease. Conclusion: The mean stay of the patients was shorter in 2020 period. These results can be explained by an early surgical management. So, early laparoscopic cholecystectomy should be considered as a treatment for acute cholecystitis in COVID-19 times if the clinical and hospital situation allows it. We found no differences in the number of patients diagnosed with acute cholecystitis between the two periods, nor in the mean number of days from the onset of symptoms.

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