Open AccessPopulation‐based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases
Author(s) -
Ravinder Vohra,
Sandro Pasquali,
Amanda Kirkham,
Philip J. Marriott,
Marianne Johnstone,
Philip Spreadborough,
Derek Alderson,
Ewen A. Griffiths,
Stephen Fenwick,
Mohamed Elmasry,
Quentin Nunes,
David Kennedy,
Raja B. Khan,
Muhammad Aamir Khan,
Conor Magee,
Steven M. Jones,
Denise Mason,
Ciny P. Parappally,
Pawan Mathur,
M Saunders,
Sara Jamel,
Samer Ul Haque,
Sara Zafar,
M H Shiwani,
Nehemiah Samuel,
Farooq Ahmad Dar,
A. Jackson,
B Lovett,
Shiva Dindyal,
Hannah Winter,
T Fletcher,
Saqib Rahman,
Kevin Wheatley,
Tom Nieto,
Soofiyah Ayaani,
H. Youssef,
Rajwinder Nijjar,
Helen Watkin,
David N Naumann,
S Emeshi,
Piyush Sarmah,
K Lee,
Nikita Joji,
Jonathan Heath,
Rebecca L. Teasdale,
C Weerasinghe,
Paul J. Needham,
Hannah Welbourn,
Luke Forster,
David Finch,
Jane Blazeby,
William Robb,
Angus McNair,
Alex Hrycaiczuk,
Alexandros Charalabopoulos,
Sritharan Kadirkamanathan,
C-B Tang,
Naga Venkatesh Jayanthi,
Nigel Noor,
Brian Dobbins,
Andrew J. Cockbain,
April Nilsen-Nunn,
José F. Siqueira,
Mike Pellen,
J Cowley,
WM Ho,
V Miu,
Timothy J. White,
Kathryn A. Hodgkins,
Alison Kinghorn,
Matthew G. Tutton,
Y A Al-Abed,
Donald Menzies,
A Ahmad,
Joanna B. Reed,
Sujoy Khan,
David Gabriel Monk,
Louis J. Vitone,
Ghulam Murtaza,
A Joel,
Stephen Brennan,
David Shier,
C Zhang,
Thusidaran Yoganathan,
Steven J Robinson,
Iain McCallum,
Michael Jones,
Mohammed Elsayed,
Liz Tuck,
J Wayman,
Kate Carney,
Somaiah Aroori,
Kenneth B. Hosie,
Adam Kimble,
David Bunting,
Adeshina S. Fawole,
Mohammed Basheer,
Rajiv Dave,
J Sarveswaran,
Elinor Jones,
C Kendal,
Michael P. Tilston,
Martin Gough,
Tom Wallace,
Surya Singh,
J Downing,
Katherine Mockford,
Eyad Issa,
Nayab Shah,
N Chauhan,
Timothy R. Wilson,
Amir Forouzanfar,
Jonathan Wild,
Emma Nofal,
Catherine Bunnell,
Khaliel Madbak,
Sudhindra T. V. Rao,
Laurence Devoto,
Najaf Siddiqi,
Zechan Khawaja,
James Hewes,
Laura Gould,
A Chambers,
D. Urriza Rodriguez,
G. Sen,
Stuart Robinson,
Francis Bartlett,
David Rae,
Tom Stevenson,
Kas Sarvananthan,
Simon Dwerryhouse,
Simon Higgs,
Oliver Old,
Thomas J. Hardy,
Reena Shah,
Steve Hornby,
Ken Keogh,
L Frank,
Musallam Al-Akash,
Emma Upchurch,
Richard Frame,
Michael Hughes,
C Jelley,
Simon Weaver,
Sudipta Roy,
Toritseju O. Sillo,
Giorgios Galanopoulos,
Tamzin Cuming,
Pedro Cunha,
Salim Tayeh,
Sarantos Kaptanis,
Mohamed Heshaishi,
Abdalla Eisawi,
Michael Abayomi,
Wee Sing Ngu,
Katie Fleming,
Dalvir Bajwa,
Vivek Chitre,
Kamal Aryal,
Paul Ferris,
M Silva,
Simon Lammy,
S Mohamed,
Amir Khawaja,
Anwar Hussain,
Mudassar Ghazanfar,
Maria Irene Bellini,
Hamdi Ebdewi,
Mohamed Elshaer,
Gianpiero Gravante,
Benjamin Drake,
Arikoge Ogedegbe,
Dipankar Mukherjee,
Chanpreet Arhi,
L Giwa Nusrat Iqbal,
Nicholas FS Watson,
S Aggarwal,
Philippa Orchard,
Eduardo Villatoro,
P. D. Willson,
K Wa,
Janice Mok,
Thomas Woodman,
Jean Deguara,
Giuseppe Garcea,
Benoy I. Babu,
Ashley R. Dennison,
Deep J. Malde,
David Lloyd,
S Satheesan,
Omer AlTaan,
Alex Boddy,
John Slavin,
R P Jones,
Laura Ballance,
Stratos Gerakopoulos,
Periyathambi Jambulingam,
S Mansour,
Naomi Sakai,
V Acharya,
Mohammed M. Sadat,
L Karim,
Frank Larkin,
Khalid Amin,
Amarah Khan,
Jennifer Law,
Saurabh Jamdar,
Stella Smith,
Keerthika Sampat,
Kathryn O’Shea,
Mangta Manu,
Fotini M. Asprou,
Nabeela Malik,
Jessica R. Chang,
Michael Lewis,
Geoffrey Roberts,
Babu Karavadra,
Evangelos Photi,
Derek O’Reilly,
Anthony Rate,
Hema Sekhar,
Lucy T. Henderson,
Benjamin Starmer,
P Coe,
Sotonye Tolofari,
Jenifer Barrie,
Gareth Bashir,
Jake Sloane,
Suroosh Madanipour,
Constantine Halkias,
Alexander Trevatt,
David W Borowski,
Jane Hornsby,
Michael Courtney,
Suvi Virupaksha,
Keith Seymour,
Helen Hawkins,
S Bawa,
Paul V. Gallagher,
Alistair Reid,
Peter A. Wood,
G Finch,
Jevin Parmar,
E Stirland,
James Gardner-Thorpe,
Ahmed Al-Muhktar,
M. Peterson,
Azeem Majeed,
Farrukh M. Bajwa,
Jack Martin,
A Choy,
Andrew Tsang,
Naresh Pore,
D R Andrew,
Waleed AlKhyatt,
Christopher Taylor,
Sumit Bhandari,
Dhivya Subramanium,
Simon Toh,
N C Carter,
S Mercer,
B Knight,
Steven Tate,
Belinda Pearce,
Denise Wainwright,
Vardhini Vijay,
Swethan Alagaratnam,
Sidhartha Sinha,
Shamsi ElHasani,
Adnan Hussain,
Vish Bhattacharya,
Nisheeth Kansal,
Tani Fasih,
Claire Jackson,
M N Siddiqui,
Imran Chishti,
Imogen Fordham,
Zohaib Siddiqui,
Harald Bausbacher,
Ileana Geogloma,
Kabita Gurung,
George Tsavellas,
Pradeep Basynat,
Ashish Shrestha,
Sanjoy Basu,
Alok Chhabra Mohan Harilingam,
Mohamed Rabie,
Mansoor Akhtar,
Pardeep Kumar,
Sadaf Jafferbhoy,
N Hussain,
Soulat Raza,
Manzarul Haque,
Imran Alam,
Rabiya Aseem,
Saloni Patel,
Mehek Asad,
M. Booth,
William Robert Ball,
Christopher P. Wood,
AnaCatarina PinhoGomes,
Ambareen Kausar,
Moh’d Rami Obeidallah,
Joseph Varghase,
Joshil Lodhia,
D Bradley,
C Rengifo,
David Lindsay,
Sivakumar Gopalswamy,
I. G. Finlay,
Stacy Wardle,
Naomi Bullen,
Syed Yusuf Iftikhar,
Altaf Awan,
Jamil Ahmed,
Paul Leeder,
Giuseppe Fusai,
Giles BondSmith,
Alicja Psica,
Yogesh Puri,
David Hou,
Fergus Noble,
Károly Szentpáli,
Jack Broadhurst,
Ravindra Daté,
Martin Hossack,
Yan Li Goh,
Paul Turner,
Vinutha Shetty,
Margarita Riera-Montes,
CAW Macano,
Anisha Sukha,
Shaun R. Preston,
Jennifer R. Hoban,
Daniel J. Puntis,
Sophie V. Williams,
Richard Krysztopik,
James Kynaston,
Jeremy Batt,
Matthew Doe,
Andrzej Gościmski,
Gareth H. Jones,
Claire Hall,
N Carty,
Sofoklis Panteleimonitis,
Rohan Gunasekera,
Andrea Sheel,
Hannah Len,
Caroline Hindley,
Marcus Reddy,
Ross Kenny,
Natalie Elkheir,
Emma Rose McGlone,
R Rajaganeshan,
Kate Hancorn,
Anita Hargreaves,
Rajendra Prasad,
David Longbotham,
Dhakshinamoorthy Vijayanand,
Imeshi Wijetunga,
Paul Ziprin,
Christopher R. Nicolay,
Geoffrey Yeldham,
E. Read,
James Gossage,
Rachel Rolph,
Husam Ebied,
Manraj Phull,
Mohammad Amanullah Khan,
Matthew Popplewell,
Dimitrios A. Kyriakidis,
Natasha Henley,
Jessica Packer,
L.F. Derbyshire,
Jonathan Porter,
S Appleton,
M Farouk,
Melvinder Basra,
Neil Jennings,
Shahda Ali,
Venkatesh Kanakala,
Haythem Ali,
R Lane,
Richard Dickson-Lowe,
Prizzi Zarsadias,
Darius F. Mirza,
Susana Puig,
Khalid Al Amari,
Deepak Vijayan,
Robert P. Sutcliffe,
Ravi Marudanayagam,
Zaed Hamady,
Abheesh R. Prasad,
Abhilasha Patel,
Damien Durkin,
Parminder Kaur,
Laura Bowen,
James Byrne,
Katherine Pearson,
Theo Georgiou Delisle,
James Davies,
Mark Tomlinson,
Michelle Johnpulle,
Corinna Slawinski,
A Macdonald,
James Nicholson,
K Newton,
James Mbuvi,
Ansar Farooq,
Bhavani Sidhartha Mothe,
Zakhi Zafrani,
Daniel Brett,
James Francombe,
J. Barnes,
Melanie Cheung,
Ahmed Z. Al-Bahrani,
Giuseppe Preziosi,
Tomas Urbonas,
Justin Alberts,
Mekhlola Mallik,
Krashna Patel,
Ashvina Segaran,
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Pratik Sufi,
C. Yao,
Sarah Pollock,
Antonio Manzelli,
Saj Wajed,
Michail Kourkulos,
Roberto Pezzuto,
Martin Wadley,
Emma Hamilton,
Shameen Jaunoo,
Robert Padwick,
Mazin Sayegh,
Richard C. Newton,
Madhusoodhana Hebbar,
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John Spearman,
Mohammed Hamdan,
C D'Costa,
Christine Blane,
Mathew Giles,
Mark Peter,
Natalie A. Hirst,
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T. Morrison,
Greg W. Taylor,
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K McCune,
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Duncan Simpson,
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Matthew MacArtney,
Tom Diamond,
Phil Davey,
Conor Jones,
Joshua Michael Clements,
Ruairi Digney,
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Stephen McCain,
Sadaf Gull,
Adam Janeczko,
Emmet Dorrian,
Andrew B. Harris,
Suzanne Dawson,
Dorothy Johnston,
Barry McAree,
Essam Ghareeb,
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Stephen McKenzie,
Krzysztos Cieplucha,
Gary Spence,
W Campbell,
Gareth Hooks,
N. W. Bradley,
A Hill,
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Michael R. Boland,
P. Burke,
Deirdre Nally,
Elmoataz Khogali,
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Gerry McEntee,
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Adrian O’Sullivan,
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Paul Carroll,
Ivan Ivanovski,
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Michael E. Kelly,
Emir Hoti,
Donal Maguire,
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Frank McDermott,
Keith S. Cross,
Fiachra Cooke,
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Yuwaraja Nedujchelyn,
M Fahad Ullah,
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Francesco Giovinazzo,
James Milburn,
Sarah Prince,
Eleanor Brooke,
Joanna Buchan,
Ahmed Khalil,
Elizabeth M. Vaughan,
Michael I. Ramage,
Roland C. Aldridge,
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Cherith M. L. R. Sutton,
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Craig R. Forrest,
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Ahmad H. M. Nassar,
Mavis Orizu,
Katrina Knight,
Haitham Qandeel,
Stuart Suttie,
Rowena Belding,
Andrew McClarey,
Alan T. Boyd,
Graeme J.K. Guthrie,
Shujing Jane Lim,
Andreas Luhmann,
A Watson,
Colin H. Richards,
Laura Nicol,
Marta J. Madurska,
Ewen M. Harrison,
Kathryn Boyce,
Amanda Roebuck,
Graeme Ferguson,
Pradeep Pati,
Megan Wilson,
Faith Dalgaty,
L Fothergill,
P Driscoll,
Kirsty L. Mozolowski,
Victoria Banwell,
Stephen Bennett,
Paul N. Rogers,
Claire Rutherford,
Ahmed K. Mirza,
T Lazim,
Henry C. C. Lim,
D Duke,
Talat Ahmed,
William Beasley,
Marc D. Wilkinson,
G Maharaj,
Cathy Malcolm,
Timothy H. Brown,
Guy Shingler,
Nicholas Mowbray,
Rami Radwan,
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A L Baker,
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Hrishikesh Shenoy,
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Deepak SinghRanger,
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Stephen O’Neill,
J Terrace,
Sara Napetti,
Benjamin Hopwood,
T Rhys,
Sam Kanavati,
Maria Coats,
Д. А. Александров,
Charlotte Kallaway,
Yahya Salama,
Alexa Templeton,
Martin J. Trotter,
Christina Lo,
Ajit Dhillon,
N Heywood,
Y Aawsaj,
Alhafidz Hamdan,
O Reece-Bolton,
Andrew McGuigan,
Yousef Shahin,
Aysha Ali,
Ali Alison Luther,
I Rajendran,
Matthew Boal,
Judith Ritchie
Publication year - 2016
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.10288
Subject(s) - medicine , cholecystectomy , endoscopic retrograde cholangiopancreatography , gallbladder , cholecystitis , biliary colic , population , gallbladder disease , emergency department , magnetic resonance cholangiopancreatography , general surgery , logistic regression , cohort , prospective cohort study , emergency medicine , surgery , pancreatitis , environmental health , psychiatry
Background The aims of this prospective population‐based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals. Methods Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non‐biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m 2 , who presented with acute cholecystitis with an ultrasound scan showing a thick‐walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals. Conclusion Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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