scholarly journals 152 Evaluating the Incidence and Predictors of Readmission in Patients Awaiting Cholecystectomy for Previously Diagnosed Acute Gallstone Disease

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Noureldin ◽  
H Razzaq ◽  
K L Whelan ◽  
A Najdawi ◽  
L Wong ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Negative Impact ◽  
Gallstone Disease ◽  
Admission Rate ◽  
Major Complication ◽  
Waiting List ◽  
Biliary Colic ◽  
P Value ◽  
Gallstone Pancreatitis ◽  
Complication Rates

Abstract Introduction The prevalence of gallstones up to 15%.20-40% will develop symptomatic gallstones and occupy most of the surgical waiting list. The timing of a cholecystectomy remains controversial. Method Retrospective data analysis over 2 years, including: diagnosis, commodities, ASA class, investigations, readmissions numbers and causes, time to surgery, operative details, and rate of conversion to open procedures. Chi-square test was used for analysis. Results 532 cholecystectomies were performed.44% of the patients had commodities. Presentations were; Acute cholecystitis (41.7%), biliary colic (23.1%), acute pancreatitis (15.9), obstructive jaundice (9.2%). USS was performed in 97.3%, CT scan in 17.8% and MRCP in 45.8%. 14% had ERCP. Re admission rate was 56.4%, between 1-6 times, secondary to; cholecystitis (12.5%), biliary colic (26.7), gallstone pancreatitis (8.2%), obstructive jaundice (8.0%), other complications (0.5-1.5%). Emergency cholecystectomy was performed in 14.9% with conversion rate 1.4%.major complication rate was 2.7. The median time on waiting list was 12 (0-123) weeks. This prolonged to 25 (0-400) weeks, when calculated at time of diagnosis. Complicated gallstones disease (p-value 0.0001) was predictors of recurrent symptoms and readmissions. Conclusions Management plan is due to optimize the timing of cholecystectomy to decrease the negative impact on readmission and complication rates plus the hospitals’ bed capacity and costs.

scholarly journals EP.TH.249Evaluating the incidence and predictors of readmission in patients awaiting cholecystectomy for previously diagnosed acute gallstone disease

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Khaled Noureldin ◽  
Humayun Razzaq ◽  
Amal Najdawi ◽  
Georgina Dick ◽  
Katy-Louise Whelan ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Obstructive Jaundice ◽  
Acute Cholecystitis ◽  
Waiting Time ◽  
Gallstone Disease ◽  
Biliary Colic ◽  
P Value ◽  
Female Ratio ◽  
Time To Surgery ◽  
Conversion Rates

Abstract Background Recurrent hospital admission remains a major issue with patients awaiting surgery for symptomatic gallstones. We evaluated the incidence and predictors of readmission in patients previously admitted with acute gallstone disease. Patients and Method We analysed laparoscopic cholecystectomies performed between January 2018 and December 2019. Data relating to the acute index admissions, readmissions, waiting time to surgery, operative details including emergency, elective procedures and conversion rates were analysed. Results 532 procedures were performed over a two-year period. Patients with non-acute gallstones (111), primary open (4) and abandoned procedures (2) were excluded. Median age 415 included patients was 50(13-89) years and a male to female ratio of 1:3. Index admission presentations were acute cholecystitis (41.7%), biliary colic (23.1%), pancreatitis (15.9), obstructive jaundice (9.2%) and combinations (10.1%). 56.4% of the of the patients were readmitted between 1-6 times before surgery. Readmission diagnoses were cholecystitis (12.5%), biliary colic (26.7), pancreatitis (8.2%), obstructive jaundice (8.0%), acute cholecystitis with gallbladder perforation and abscess (0.5%), post-ERCP pancreatitis (0.5%) and pancreatic pseudocyst (0.2%). 14.9% of the patients underwent emergency procedures. Overall conversion rate was 1.4%. Median waiting time to surgery was 12(0-123) weeks. Waiting time to surgery was significantly lower in gallstone pancreatitis compared with other presentations (p-value 0.008). Acute pancreatitis (p-value 0.0001) and complicated index presentations (p-value 0.0001) were predictors of recurrent symptoms and readmission. Age, gender, comorbidities, high BMI, ASA have no significant impact on readmission episodes. Conclusion Readmission is a common occurrence following acute gallstone attacks with acute pancreatitis and complicated index presentations as significant predictors.

Management of Complicated Gallstone Disease

2019 ◽  
Author(s):  
Glenn Wakam ◽  
Dana Telem
Keyword(s):  
Bile Duct ◽  
Gallbladder Disease ◽  
Gallstone Ileus ◽  
Gallstone Disease ◽  
The United States ◽  
Biliary Colic ◽  
General Surgeon ◽  
Gallstone Pancreatitis ◽  
Complication Rates ◽  
Critical View Of Safety

Nearly 9% of men and 30% of women in the United States experience symptoms or complications of gallstone disease. As such, nearly every general surgeon in the country encounters patients with this pathology numerous times during his or her career. Cholelithiasis can cause complications such as acute cholecystitis, choledocholithiasis, gallstone pancreatitis, and the rare entities of Mirizzi syndrome and gallstone ileus. Patients with gallstones have a 1 to 3% risk per year of a complication, and that risk increases significantly to 30% in those with biliary colic. Surgical management of the complications of gallstones is especially intriguing because the cases are often perceived as low complexity; however, it is an operation that can challenge even the most seasoned attending and result in significant complications. Studies demonstrate complication rates up to 10% following cholecystectomy, with bile duct injury rates hovering at 4 in 1,000. This chapter aims to provide the reader with knowledge of the presentation, imaging, work-up, and framework for the management of complicate gallbladder disease. Furthermore, we hope to provide you with a foundation of how to perform a safe cholecystectomy in a variety of circumstances and impart a few tips and tricks for some challenging intraoperative situations. This review contains 2 figures, and 55 references. Key Words: cholecystitis, choledocholithiasis, cholescintigraphy, common bile duct exploration, critical view of safety, ERCP, gallstone pancreatitis, subtotal cholecystectomy

scholarly journals Gallstones: new insights into an old story

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1817 ◽  
Author(s):  
Evan Tiderington ◽  
Sum P. Lee ◽  
Cynthia W. Ko
Keyword(s):  
Gallstone Disease ◽  
Stone Disease ◽  
Biliary Colic ◽  
Cholesterol Stone ◽  
Gallstone Pancreatitis ◽  
Alcoholic Fatty Liver ◽  
Cholesterol Gallstones ◽  
Timing Of Cholecystectomy ◽  
Clinical Associations ◽  
Alcoholic Fatty Liver Disease

Gallstones, particularly cholesterol gallstones, are common in Western populations and may cause symptoms such as biliary colic or complications such as acute cholecystitis or gallstone pancreatitis. Recent studies have allowed for a better understanding of the risk of symptoms or complications in patients with gallstones. In addition, newer data suggest an association of gallstones with overall mortality, cardiovascular disease, gastrointestinal cancers, and non-alcoholic fatty liver disease. Knowledge of appropriate indications and timing of cholecystectomy, particularly for mild biliary pancreatitis, has gradually accumulated. Lastly, there are exciting possibilities for novel agents to treat or prevent cholesterol stone disease. This review covers new advances in our understanding of the natural history, clinical associations, and management of gallstone disease.

scholarly journals Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

2011 ◽  
Vol 93 (7) ◽  
pp. 261-265
Author(s):  
AJ Cockbain ◽  
AL Young ◽  
E McGinnes ◽  
GJ Toogood
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Cochrane Review ◽  
Length Of Hospital Stay ◽  
Biliary Colic ◽  
Complication Rates ◽  
Acute Surgery ◽  
Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

scholarly journals P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jacob Mewse ◽  
Virginia Ledda ◽  
Ellie Connor ◽  
Peter Frank Mason
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Time ◽  
Negative Impact ◽  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Emergency Operation ◽  
Biliary Colic ◽  
Emergency General Surgery

Abstract Background Gallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment. Methods We identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC. Results A total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks. Conclusions This audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

scholarly journals 555 Should All Acutely Presenting Gallstone Disease Be Managed Surgically?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Rehman ◽  
A Khan ◽  
R Wunnava
Keyword(s):  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
The Other ◽  
Gallstone Pancreatitis ◽  
Complication Rates ◽  
Retrospective Audit ◽  
History Of ◽  
Emergency Cholecystectomy ◽  
Elective Cholecystectomy

Abstract Aim This audit aims to assess if gallstone complications can be prevented by performing an emergency cholecystectomy in acutely presenting gallstone disease. Factors taken into consideration include number of presentations to hospital before surgery, secondary admissions of pancreatitis or cholangitis, subsequent requirements of ERCP as well as complication rates of elective and emergency surgery. Method Retrospective audit looking at 387 cholecystectomies carried out, within a year, at Walsall Manor Hospital. Results Approximately 20% of patients had an emergency cholecystectomy. A total of 192 patients had at least one admission, with 17% having a minimum second. Seven patients went on to develop gallstone pancreatitis subsequently, as well as eight requiring at least a minimum of one ERCP. The complication rate in elective surgery was higher at 4.1% compared to 2.7% in emergency cases. Long waiting times for surgery put patients at greater risk of complications. 96% (26/27) of elective cholecystectomy patients, who suffered an attack of pancreatitis, had to wait more than four weeks. Furthermore, 39% (47/119) of those who had a minimum of one admission had to wait more than 20 weeks. On the other hand, three-quarters of patients who were operated in emergency went home within 48 hours, with the figures being not too dissimilar from elective cases with a history of admission (76%). Conclusions Performing emergency cholecystectomies in the same admission or on a dedicated hot list would not only decrease the risk, but also the potential risk of developing gallstone complications.

Gallstone disease

2018 ◽  
pp. 401-414
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Gallstone Disease ◽  
Acute Cholangitis ◽  
Biliary Colic ◽  
Ultrasound Scan ◽  
Bile Duct Stones ◽  
Clinical Presentations ◽  
Laparoscopic Bile Duct Exploration

Gallstone disease is common with clinical presentations including biliary colic, cholecystitis, and obstructive jaundice. Acute cholangitis and pancreatitis are other complications. Ultrasound scan and MRCP as well as endoscopic ultrasound are investigation modalities. Medical treatment of gallstones with ursodeoxycholic acid is discussed as well as laparoscopic cholecystectomy with its risks and benefits. The prevalence of bile duct stones is around 10–20%. Strategies for investigation and management are discussed, including ERCP and laparoscopic bile duct exploration.

scholarly journals 883 Modified Framework for The Management of Acute Gallstone Disease During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A White ◽  
J Brewer ◽  
E Efthimiou ◽  
H Khwaja ◽  
G Bonanomi
Keyword(s):  
Gallstone Disease ◽  
Operative Management ◽  
Definitive Treatment ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Global Pandemic ◽  
Early Adoption ◽  
Efficient Resource ◽  
Non Operative Management

Abstract Introduction On 12/03/2020 WHO declared SARS-CoV-2 a global pandemic. PHE and RCS advised non-operative management wherever possible, changing management of acute gallstone disease from early laparoscopic cholecystectomy to conservative treatment and frequent percutaneous drainage. Planning, prioritisation, and implementation of “COVID-Safe” pathways presented multi-factorial challenges throughout the NHS. Method Prospective data of patients admitted with acute gallstone pathology was collected at Chelsea & Westminster Hospital (23/03/2020-16/08/2020), and prioritised using Tokyo, FSSA and RCS Guidance. A restructured “Gallbladder-pathway” was implemented comprising trust-wide referral proforma, weekly clinical planning MDT meetings and dedicated theatre lists. Results Sixty-eight patients were prioritized as either “Urgent” (25), “Expedited” (12) or “Elective” (31); comprising gallstone pancreatitis (11), acute cholecystitis (53), obstructive jaundice (12) and biliary colic (8). 12 patients required cholecystostomies. During the “Peak” (23/3/20-02/06/2020) no cholecystectomies were performed, 10 in “Recovery” (02/06/20-06/07/20) in NCEPOD theatre, 21 in “Resolution” (06/07/20-18/08/20) since implementation of the “Gallbladder-Pathway”. Eleven patients (16%) re-presented while awaiting definitive treatment, none critically ill. The highest number of re-presentations was in “Urgent” patients (36%) and those with cholecystostomy (45%). Conclusions Early adoption of a modified “Gallbladder-pathway” during the pandemic allowed accurate case stratification, efficient resource allocation and safe care. Our model enabled prompt service recovery and a framework to navigate future disruption.

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

2021 ◽  
pp. 205141582098766
Author(s):  
Joseph B John ◽  
Angus MacCormick ◽  
Ruaraidh MacDonagh ◽  
Mark J Speakman ◽  
Ramesh Vennam ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Local Anaesthetic ◽  
Complication Rate ◽  
Admission Rate ◽  
Prophylactic Antibiotics ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Hospital Admission Rate ◽  
Prostate Biopsies ◽  
Disease Characteristics

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.

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