Talk at the Royal Australasian College of Surgeons Meeting in Brisbane by Sonia Tran, Amjid Riaz, Joel Zhou, Kirsten Hepburn and Michael Talbot
An association between creation of an Acute Surgical Unit (ASU) and improved outcomes in the management of acute cholecystitis was recently demonstrated. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional “generalist” General Surgery approach or the ASU model.
Methodology: A 6 year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy.
Results: 629 emergency laparoscopic cholecystectomies performed over this time. 488 patients were available for analysis. The mean time to operation was 42 hours and mean length of operation was 88 minutes. 86% were performed during daylight hours. 8 cases were converted to open surgery (1.64%). Intraoperative cholangiography was performed in 405 patients. The major complication rate was 9.8%, including common duct stones (4.7%), sepsis (1.23%), postoperative bleeding (1.22%), re-admission (1.02%), bile leak (0.81%), NSTEMI, (0.41%), unscheduled return to theatre (0.41%) and pneumonia (0.20%). There were no mortalities and no CBD injuries.
Conclusions: Over a time period that encompasses the current publications on the ASU model, a subspecialty model of care has shown consistent results that exceed established benchmarks. This study generates the hypothesis that subspecialty management of patients with complex emergency pathologies should be considered a valid alternative to ASU.
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