Abstract
Introduction: Most acute biliary presentations involve gallstones and cholecystectomy is common. Concern regarding obstructive biliopathy occasionally warrants magnetic resonance cholangiopancreatography (MRCP). However, this delays time to intervention and increases length of hospital stay. Given operative cholangiography is within the skills of general surgeons, can MRCP be justified? This study examines MRCP indications in acute surgical patients. Patients with biliary colic/cholecystitis forms an interest group. Outcomes are analyzed to identify if MRCP led to a change in management. Methods: A 12-month retrospective review of all acute surgical admissions undergoing inpatient MRCP at an Australian metropolitan hospital was undertaken. Clinical and MRCP details (Indication; Time to MRCP; MRCP change in management) were collated. Delay to intervention, wasted bed days and a cost analysis of unnecessary MRCP expenditure was calculated. Results: A total of 64 patients qualified for analysis. Lead admission diagnoses were biliary colic (34.4%), cholecystitis (20.3%) and pancreatitis (17.2%). MRCP was indicated for choledocholithiasis in 68.8%. Time to MRCP was a mean of 21hrs (+/-20.58) with a range of 2-96hrs. MRCP was deemed to have changed management in 17.2% of all cases and only 11.4% in patients with biliary colic/cholecystitis specifically. The potential savings owing to MRCP that didn’t change management was $146,900AUD overall. Conclusion: In an environment where cholecystectomy and operative cholangiogram are common, MRCP rarely changes management. The potential improvements in clinical efficiency are significant with cost savings. MRCP should be considered carefully, particularly when cholecystectomy with cholangiogram is already indicated. There remains small subset of patients in whom MRCP can be of great utility.
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