Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;48(1):23-35.
doi: 10.1007/s00068-020-01433-x. Epub 2020 Jul 7.

Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES 'snapshot audit' of practice

Gary Alan Bass  1   2   3   4 , Amy Gillis  5 , Yang Cao  6 , Shahin Mohseni  7   8 ; European Society for Trauma, Emergency Surgery (ESTES) Cohort Studies Group
Collaborators, Affiliations

Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES 'snapshot audit' of practice

Gary Alan Bass et al. Eur J Trauma Emerg Surg. 2022 Feb.

Erratum in

Abstract

Background: Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level.

Aim: To identify, through an international prospective nonrandomized cohort study, the epidemiology and areas of practice variability in management of acute complicated calculous biliary disease (ACCBD) and to correlate them against reported outcomes.

Methods: A preplanned analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Complicated Biliary Calculous Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. All eligible patients with acute complicated biliary calculous disease were recorded contemporaneously using a standardized predetermined protocol and a secure online database and followed-up through to 60 days from their admission.

Endpoints: A two-stage data collection strategy collecting patient demographics, details of operative, endoscopic and radiologic intervention, and outcome metrics. Outcome measures included mortality, surgical morbidity, ICU stay, timing of operative intervention, and length of hospital stay.

Results: Three hundred thirty-eight patients were included, with a mean age of 65 years and 54% were female. Diagnosis at admission were: cholecystitis (45.6%), biliary pancreatitis (21%), choledocholithiasis with and without cholangitis (13.9% and 18%). Index admission cholecystectomy was performed in just 50% of cases, and 28% had an ERCP performed. Morbidity and mortality were low.

Conclusion: This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich 'real world' insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study.

Keywords: Cholecystectomy; Cholecystitis; Clinical practice guidelines; Emergency surgery.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Patient flow diagram
Fig. 2
Fig. 2
Twenty-five centers in nine countries (Austria, Ireland, Italy, Portugal, Romania, Spain, Sweden, UK, USA) participated in the inaugural ESTES Snapshot Audit
See this image and copyright information in PMC

References

    1. Nguyen CL, Dijk A, Smith G, Leibman S, Mittal A, Albania M, et al. Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters. Anz J Surg. 2019;90:295–299. doi: 10.1111/ans.15603. - DOI - PubMed
    1. Gutt CN, Encke J, Köninger J, Harnoss J-C, Weigand K, Kipfmüller K, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304) Ann Surg. 2013;258:385–393. doi: 10.1097/SLA.0b013e3182a1599b. - DOI - PubMed
    1. Harai S, Mochizuki H, Kojima Y, Nakagomi K, Yoshimura D, Takaoka S, et al. Validation of Tokyo Guideline 2013 as treatment of acute cholecystitis by real world data. Digest Dis. 2019;37:303–308. doi: 10.1159/000496738. - DOI - PubMed
    1. Bourikian S, Anand RJ, Aboutanos M, Wolfe LG, Ferrada P. Risk factors for acute gangrenous cholecystitis in emergency general surgery patients. Am J Surg. 2015;210:730–733. doi: 10.1016/j.amjsurg.2015.05.003. - DOI - PubMed
    1. Portinari M, Scagliarini M, Valpiani G, Bianconcini S, Andreotti D, Stano R, et al. Do I need to operate on that in the middle of the night? Development of a nomogram for the diagnosis of severe acute cholecystitis. J Gastrointest Surg. 2018;22:1016–1025. doi: 10.1007/s11605-018-3708-y. - DOI - PubMed