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Observational Study
. 2024 Sep;106(7):601-609.
doi: 10.1308/rcsann.2023.0084. Epub 2023 Dec 1.

Paradigm shift towards emergency cholecystectomy: one site experience of the Chole-QuiC process

M Hamid  1 , J Bird  1 , J Yeo  1 , A Shrestha  1 , M Carter  1 , K Kudhail  1 , A Akingboye  1 , C Sellahewa  1
Affiliations
Observational Study

Paradigm shift towards emergency cholecystectomy: one site experience of the Chole-QuiC process

M Hamid et al. Ann R Coll Surg Engl. 2024 Sep.

Abstract

Introduction: Substantial evidence exists for the superiority of emergency over delayed cholecystectomy for gallstone disease during primary admission. Despite this, emergency surgery rates in the UK remain low compared with other developed countries, with great variation in care across the nation. We aimed to describe the local paradigm shift towards emergency surgery and investigate outcomes.

Methods: This is a prospective observational study examining patients enrolled onto an emergency cholecystectomy pathway, following the hospital's subscription to the Royal College of Surgeons of England's Cholecystectomy Quality Improvement Collaborative (Chole-QuIC), between 1 December 2021 and 31 January 2023. Multivariate logistical regression models were used to identify patient and hospital factors associated with postoperative outcomes.

Results: Of the 307 suitable acute admissions, 261 (85%) had an emergency cholecystectomy, compared with 5% preceding the Chole-QuIC interventions. Waiting time dropped from 67 to 5 days. A total of 208 (79.7%) patients were primary presentations, 92 (35.2%) were classed Tokyo grade 2 and 142 (54.4%) were obese. A total of 23 (8.8%) patients underwent preoperative endoscopic retrograde cholangiopancreatography, and 26 (10%) patients had a subtotal cholecystectomy. Favourable outcomes (Clavien Dindo ≥3) were observed in first presentations (odds ratio (OR) 0.35; p=0.042) and for operation times within 7 days (OR 0.32; p=0.037), with worse outcomes in BMI ≥35 (OR 3.32; p=0.005) and operation time >7 days (OR 3.11; p=0.037).

Conclusion: A paradigm shift towards emergency cholecystectomy benefits both the patient and the service. Positive outcomes are apparent for early operation in patients presenting for the first time and recurrent attendees, with early operation (<7 days) providing the most favourable outcome in a select patient group.

Keywords: Acute cholecystitis; Complications; Emergency cholecystectomy; Patient outcomes; Readmission; Subtotal cholecystectomy.

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Figures

Figure 1
Figure 1
Admission to surgery waiting time over the study period
See this image and copyright information in PMC

References

    1. Gurusamy K, Samraj K, Gluud Cet al. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97: 624–624. - PubMed
    1. Gurusamy KS, Koti R, Fusai G, Davidson BR. Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic. Cochrane Database Syst Rev 2013; 6: CD007196. - PMC - PubMed
    1. Macafee DAL, Humes DJ, Bouliotis Get al. Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg 2009; 96: 1031–1040. - PubMed
    1. Gurusamy KS, Farouk M, Tweedie JH. UK guidelines for management of acute pancreatitis: is it time to change? Gut 2005; 54: 1344–1345. - PMC - PubMed
    1. CholeS Study Group, West Midlands Research Collaborative. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases: variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103: 1716–1726. - PubMed

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