Influence of Preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) on Bacterial Colonization of Biliary Tract in Patients Surgically Treated for Obstructive Jaundice

Abstract

Introduction: Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services.

Methods: This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included.

Results: Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital "Abdulah Nakas", 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery, (33.51%), surgery cancelled due to medical/anesthetic reasons, (31.38%), surgical procedure cancelled by the surgeon on the day of surgery, (11.97%).

Conclusion: This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.

Keywords: avoidable and unavoidable causes; cancellation of surgical procedures; improvement of quality; reasons for cancelling.

Chart 1.. Patients distribution by age

Chart 2.. Distribution of benign and malignant diseases which cause opstructive jaundice

Chart 3.. Etiology of opstructive jaundice and bactibilia occurance obstructive jaundice. In the study of Sivaraj and allies (2010),

Chart 4.. Relationship of preoperative ERCP and bactibilia there was 80 patient with pancraticoduodenectomy who have undergone preoperative ERCP and intraoperative bactibilia was found in 45 patients (14). Sand and allies (1992) have shown that patients whom ERCP was done twice have bactibilia in 60% of cases, while Neve and allies (2003) prove that even 26,1 % patients with obstructive jaundice have bactibilia in the time of ERCP (15). Hui and allies (2003) have shown that cholangitis appears 26-55% more often in patients with preoperative ERCP or some of biliary drainage procedures (16).