General Papers 08

Abstract

Aims: The high morbidity (28.5 per cent readmission rate) experienced whilst waiting for laparoscopic cholecystectomy (LC) after an index admission with acute cholecystitis (AC) has been reported. Since this report a provision for emergency LC service has been made available in the same DGH. This study performed over a 12-month period (October 2000–September 2001) reports the impact of those changes on the management of AC and allows comparisons between these results and those achieved in the previous study (the control period). Methods: During the study 146 patients presented as emergency with AC. Emergency cholecytectomy was performed in 75 and the rest were waitlisted. GI surgeons performed 76 per cent of the LC whilst the non-GI surgeons listed the majority of their cases for delayed LC. Seventy-one per cent of the LC was done laparoscopically with an 18.8 per cent conversion rate; 59 per cent (44/75) cholecystectomies were performed by trainees under supervision. The number of emergency LC, conversion rates, complications, median length of total (TLOS) and postop hospital stay (PLOS) were used as end points. Results: There was a seven-fold (Table) increase in the number of cholecystectomies during their index admission in the study group. Major complications and conversion rates of LC performed in the study period (5.3 and 18 per cent) were similar to those of delayed LC in the control period (6.2 and 12 per cent). Although the TLOS was less in the study group compared to the control (table), patients with AC still had a median wait of 5 days between their admission and their cholecystectomy. Conclusions: These results document that emergency cholecystectomy service can be provided with minimal complications and a shorter hospital stay. Further improvements to reduce inhospital stay require prompt ultrasound examination and rostering of laparoscopically competent surgeons.