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TIMING OF SURGERY FOR ACUTE SYMPTOMATIC BILIARY DISEASE
Author(s) -
Short H. L.,
Zargar Shoshtari K.,
Lee D.,
Poole G. H.,
Hill A. G.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04119_3.x
Subject(s) - medicine , perioperative , surgery , emergency surgery , disease , retrospective cohort study , general surgery
Purpose To evaluate surgical management of patients presenting with symptomatic gallstone disease to Middlemore Hospital in 2005. Method Retrospective case review of acute presentations of symptomatic gallstone disease between Jan 1st and Dec 31st 2005. Results Four hundred and two patients were included in the final analysis. Forty six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 22 declined surgery. Therefore 308 patients (77%) were eligible for surgery at index admission (IA). Sixty six percent (204) of these received surgery during IA with an average time to surgery of 4 days. Of the remaining 104 eligible patients who did not receive surgery during IA, 54% (56) received public surgery at a later date with an average wait of 85 days. Fourteen percent (42) never received surgery despite being eligible during IA. There was no significant difference in duration of total acute hospital stay between those with surgery at IA and those who did not receive surgery at IA. For those who had acute surgery the conversion rate was 2% (4). There were no biliary injuries or perioperative deaths and post‐operative readmission rate was 4% (9). Sixty two percent (64) of the 104 eligible patients who did not receive surgery at IA were subsequently readmitted acutely within 24 months. The average wait time for US, MRCP and ERCP was 0.9, 3.1 and 3.4 days respectively. Conclusion Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and cost effective.