The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

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Evaluation of suitability of simultaneous laparoscopic surgery for the treatment of diseases of the hepatobiliary system

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(3)-09 ◽

2020 ◽

Vol 24 (3) ◽

pp. 418-424

Author(s):

M. Halei ◽

I. Dzubanovsky ◽

I. Marchuk

Keyword(s):

Blood Pressure ◽

Gallstone Disease ◽

Recovery Period ◽

Duration Of Treatment ◽

Creatinine Concentration ◽

Oral Nutrition ◽

Results Of Treatment ◽

Significant Difference ◽

Duration Of Surgery ◽

The Impact

Annotation. Aim of work - to investigate the impact of the developed technique of simultaneous laparoscopic operations on the results of treatment of surgical hepatobiliary pathology, to analyze and compare the main indicators of efficiency and safety of own technique with the "French" technique of cholecystectomy. During period from 2013 to 2019, 253 patients with combined hepatobiliary pathology and gallstone disease were treated using our own simultaneous surgery technique (group 1) and 328 patients with only gallstone disease treated using standard 'French technique' (group 2). The comparison was made through the analysis and comparison of such indicators as the duration of treatment, duration of surgery, serum creatinine concentration, glycemia, blood pressure. Shapiro-Wilk statistical methods, Mann-Whitney criteria or U-test were used. The following results were obtained: the duration of the operation was 66.14±6.21 minutes in the first group against 42.6±4.72 minutes in the second and did not exceed 2 hours; blood creatinine concentration did not exceed the allowable 2 mg/dl in both groups and differed slightly (p = 0.937), normalized in the period 6-12 h; glycemia also did not differ between the study and control groups and normalized during the recovery period of oral nutrition (p=0.822); Blood pressure was monitored to maintain normotony, the difference between intraoperative parameters in both groups was insignificant (p=0.912); the length of stay had no statistically significant difference between the groups (p=0.784) and was 3.53 days for the first and 3.45 for the second group. The method is valid for modern requirements, and the technique justifies its use.

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1344. Impact of Pharmacist-Physician Team on Antimicrobial Utilization at a Pediatric Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1526 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S683-S683

Author(s):

Julia Sapozhnikov ◽

Marisol Fernandez

Keyword(s):

Pediatric Hospital ◽

Antimicrobial Utilization ◽

Time Period ◽

Days Of Therapy ◽

Significant Difference ◽

Central Texas ◽

Successful Approach ◽

Time Periods ◽

The Impact ◽

Physician Team

Abstract Background “Handshake stewardship” is now considered a leading practice in antimicrobial stewardship (AMS) by The Joint Commission. This study aims to evaluate the impact of a pharmacist-led and physician-pharmacist led handshake stewardship method on antimicrobial utilization at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a teaching children’s hospital in central Texas. We retrospectively measured hospital-wide antimicrobial utilization from June 2015 to May 2020. We compared the time periods with an ID pharmacist participating in handshake stewardship ([A] July 2012 to April 2015,[B] May 2015 to May 2018 and [D] August 2019 to May 2020) and without an ID pharmacist ([C] June 2018 to July 2019). We also compared time periods with only an ID pharmacist led ASP [A] compared to a physician-pharmacist led ASP [B].The primary endpoint was days of therapy per 1,000 patient days (DOT/1000 PD). Table 1. Overall Antimicrobial Utilization During Changes in ASP Structure Results Antimicrobial utilization during pharmacist-led ASP [A] was significantly higher than during the pharmacist-physician led ASP time period [B] (95% CI, 68.8-76.8; P=0.001). No significant difference was observed for mean hospital-wide antimicrobial, meropenem, piperacillin-tazobactam, or cefepime DOT/1000 PD from period [B] to [C]. However, the increase in mean DOT/1000 PD during these time periods was statistically significant for ceftriaxone (95% CI, 6.3-23.9; P=0.001) and vancomycin (95% CI, 1.2-18.1; P=0.03). For time period [C] to [D], there was a statistically significant reduction in mean DOT/1000 PD seen in overall antimicrobial use (95% CI, 156.9-313.6; P< 0.0001). Statistically significant decreases in DOT/1000 patient days were also seen for cefepime (95% CI, 11.4-36.4; P< 0.0007), ceftriaxone (95% CI, 5.0-24.8; P=0.005), and vancomycin (95% CI, 6.1-23.1; P=0.002). No difference was seen for piperacillin-tazobactam or meropenem DOT from [C] to [D]. Figure 1. Hospital-Wide Monthly Days of Therapy per 1000 Patient Days Conclusion Active engagement with frontline providers via handshake stewardship offers a more successful approach to decreasing antimicrobial utilization. A greater reduction in overall antimicrobial utilization was seen when the ASP was led by a pharmacist-physician team compared to when it was pharmacist-led without a physician champion. Disclosures All Authors: No reported disclosures

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Comparison of 3-port with standard 4-port laparoscopic cholecystectomy: A clinical trial

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2020.8.2.101 ◽

2020 ◽

pp. 52-57

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Gallstone Disease ◽

Control Group ◽

P Value ◽

Case Group ◽

Double Blind ◽

Laparoscopic Cholecystectomy Group ◽

Significant Difference ◽

Duration Of Surgery

Introduction: Since the laparoscopic cholecystectomy was introduced first in 1990, the 4-port laparoscopic cholecystectomy was the gold standard. The 4-port (lateral) is used to hold gallbladder fundus and observe Calot's triangle. It is discussed that the 4-port technique is not required in many patients. Therefore, this study aimed to make a comparison between 3-port and 4-port laparoscopic cholecystectomy methods in the treatment of gallstone disease. Methods: A double-blind clinical trial was performed on patients admitted to Imam Reza Hospital, Birjand, Iran. The patients with gallstone disease (n=60) were randomly assigned into the case (3-port) and control (4-port) groups using balanced block randomization and underwent 3- or 4-port laparoscopic cholecystectomy. Postoperative pain was measured by a visual analog scale four h after surgery. The amount of pain-killer, duration of surgery, as well as length of stay and scars were measured in this study. Data were analyzed statistically in SPSS software (version 18) through the Chi-square test and t-test. A p-value less than 0.05 was considered statistically significant. Results: The groups were compared in terms of demographic characteristics. There were 24 females (80%) and 6 males (20%) in the control group and 25 females (83.4%) and 5 males (16.7%) in the case group (P=0.739). Moreover, the mean ages of the control and case groups were 59.823±7.8 and 61.10±4.7, respectively, and there was no significant difference between the groups in this regard (P=0.348). Furthermore, length of operation (P=0.001) and analgesic consumption (P=0.001) in the 3-port laparoscopic cholecystectomy group were lower than those in the 4-port group; however, the hospital stay (P=0.896) was the same in both groups. Conclusions: The 3-port laparoscopic cholecystectomy is a safe, reliable, and cost-effective method in patients who underwent laparoscopic cholecystectomy.

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228 Outcomes of Gallstone Complications During the COVID Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab259.826 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Isherwood ◽

B B Karki ◽

W Y Chung ◽

T AlSaoudi ◽

J Wolff ◽

...

Keyword(s):

Gold Standard ◽

Gallstone Disease ◽

Gallbladder Perforation ◽

Gallstone Pancreatitis ◽

Biliary Disease ◽

Early Laparoscopic Cholecystectomy ◽

Significant Difference ◽

Risk Patients ◽

The Impact ◽

National Approach

Abstract Background The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate. Method This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019. Results Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al. Conclusions In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.

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Is gender a determinant for the outcome of laparoscopic cholecystectomy?

International Surgery Journal ◽

10.18203/2349-2902.isj20204992 ◽

2020 ◽

Vol 7 (12) ◽

pp. 3959

Author(s):

Akshay Bahadur ◽

S. D. Bisht ◽

Yanshul Rathi ◽

Ashish Shukla ◽

Aman Aggarwal

Keyword(s):

Risk Factor ◽

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Gallstone Disease ◽

Female Group ◽

Conversion To Open Surgery ◽

Significant Difference ◽

Male Sex ◽

Operative Findings ◽

The Impact

Background: Currently, laparoscopic cholecystectomy is one of the most desirable procedures to treat symptomatic gallstone disease. Yet, various risk factors govern its conversion to open surgery. The impact of male sex as a risk factor for conversion has been a questionable issue. The study aimed to evaluate the role of male sex on outcomes of laparoscopic cholecystectomy.Methods: As per inclusion and exclusion criteria, medical records of all the patients aged 18-70 years who underwent elective LC for a period of 14 months were accessed retrospectively. Data related to patients’ demographic details, intra-operative and post-operative findings was recorded and subjected to analysis.Results: Out of 232 selected cases, 17.67% were males and 82.32% were females. Mean age in both gender groups was similar (p=0.139). Body mass index was also found to be similar in both the groups (p=0.232). There was no significant difference (p=0.85) in the mean operative time between men (29.37±9.29) and women (28.88±15.66). Conversion to open surgery was seen only in female group (1.57%) but it is not significantly from the male group (p=0.42). No significant difference was observed in both groups regarding unwanted intra-operative events (p=0.231) and post-operative complications (p=0.70) and post- operative stay (p=0.50).Conclusions: This study suggests that male gender may not be considered as an independent risk factor for outcome of laparoscopic cholecystectomy. However, extensive research in future may cast further light on this issue.

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A study of impact of gender on operative findings and outcome in patients undergoing laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20164476 ◽

2016 ◽

Vol 4 (1) ◽

pp. 390 ◽

Cited By ~ 1

Author(s):

Saurabh Kumar ◽

Praveen Kumar ◽

Ram K. Verma ◽

Akshat Agarwal

Keyword(s):

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Gallstone Disease ◽

Female Group ◽

Conversion To Open Surgery ◽

Conversion Rates ◽

Significant Difference ◽

Duration Of Surgery ◽

One Year ◽

Operative Findings

Background: Gallstone disease (GSD) is a prevalent health problem around the globe and the treatment of choice for symptomatic GSD is laparoscopic cholecystectomy (LC). There are many factors that influence the operative findings, conversion rates and the outcome of surgery. Male gender has been considered by some to be an adverse factor in this regard. Through this study we intend to find out the role of gender in the operative findings and outcome of laparoscopic cholecystectomy.Methods: All the patients undergoing laparoscopic cholecystectomy at SMI Hospital, Dehradun during one year period were included in the study with certain exceptions. The details of clinical presentation, operative findings and conversion rates, duration of surgery and peri-operative complications were recorded separately for male and female patients and compared.Results: A total of 402 patients were included in the study. 72 (17.9%) were male and 330 (82%) were female. The mean duration of surgery was significantly greater in the male group (66 min) as compared to female group (60.5 min). The rate of conversion to open surgery was not significantly different in the two groups. There was no significant difference in frequencies of complications in the two groups.Conclusions: Gender has little role as far as overall morbidity and conversion to open surgery are concerned in patients undergoing laparoscopic cholecystectomy.

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Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02687-z ◽

2021 ◽

Author(s):

Chang Park ◽

Kapil Sugand ◽

Arash Aframian ◽

Catrin Morgan ◽

Nadia Pakroo ◽

...

Keyword(s):

Best Practice ◽

Neck Of Femur ◽

Health Crisis ◽

Femur Fractures ◽

Time Period ◽

Vulnerable Patients ◽

Significant Difference ◽

Usual Residence ◽

Hip Trauma ◽

The Impact

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

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Comparison of Complications between Direct Trocar Insertion Versus Veress Needle for Creation of Pneumoperitoneum in Patients Undergoing laparoscopic Cholecystectomy: A Randomized Control Trial

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i40a32247 ◽

2021 ◽

pp. 294-299

Author(s):

Kamran Hamid ◽

Shabbir Ahmad ◽

Bahzad Akram Khan ◽

Muhammad Faheem Answer ◽

Amer Latif ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Needle Insertion ◽

Veress Needle ◽

P Value ◽

Surgical Department ◽

Trocar Insertion ◽

Laparoscopic Entry ◽

Significant Difference ◽

Duration Of Surgery ◽

Direct Trocar Insertion

Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy. Design: Randomized controlled trial Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020. Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant. Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001). Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.

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Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

International Surgery Journal ◽

10.18203/2349-2902.isj20174898 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3740

Author(s):

Salil Mahajan ◽

Manu Shankar ◽

Vinod K. Garg ◽

Vijender Gupta ◽

Jaya Sorout

Keyword(s):

High Pressure ◽

Laparoscopic Cholecystectomy ◽

Shoulder Pain ◽

Postoperative Period ◽

Low Pressure ◽

Randomized Clinical Study ◽

Early Return ◽

Significant Difference ◽

Duration Of Surgery ◽

Bile Spillage

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

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Patient safety in the operating theatre

Pielęgniarstwo w Anestezjologii i Intensywnej Opiece ◽

10.15374/pwaiio2019021 ◽

2020 ◽

Vol 6 (2) ◽

pp. 25-31

Author(s):

Katarzyna Tomaszewska ◽

Dorota Gos

Keyword(s):

Patient Safety ◽

Operating Theatre ◽

Survey Method ◽

Length Of Service ◽

Operating Theater ◽

Level Of Education ◽

Operating Team ◽

Time Period ◽

The Impact ◽

Legal Consequences

Introduction Patient safety in the operating theatre depends on the multi-track activities of the entire medical team. Guaranteeing total patient safety will allow the patient to meet his expectations, will be a source of satisfaction for the whole team, which provides care and treatment, and helps avoid legal consequences. Aim The aim of the study was to investigate which factors, according to the operating team, guarantee patient safety in the time period from the admission to the operating theatre until the transfer to the specialist ward. Material and methods The diagnostic survey method and analysis of literature were used. A propriety questionnaire created by the authors was used in order to verify the hypotheses. Results and Conclusions There were no significant correlations between age, level of education and length of service and the assessment of the impact of other activities on patient’s safety in the operating theatre. Gender and workplace did not significantly influence the evaluation of the significance of other analysed factors. The profession did not significantly differ in the evaluation of the analysed factors for the patient safety in an operating theatre. Compliance with standards and procedures before, during and after the procedure guarantees patient safety in the operating theater to a large extent in the respondents’ opinion.

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