Index cholecystectomy for management of acute gallstone disease: a change of practice at a major New Zealand metropolitan centre

Sakowska, Magdalena; Connor, Saxon

doi:10.1111/j.1477-2574.2011.00345.x

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…6,7,23 The rationale for the 'readmission cholecystectomy' group was to reflect the common practice in our healthcare setting of discharging patients with mild AP home (due to a limited operating room time) and readmitting them for elective cholecystectomy within four weeks. 24,25 The number of recurrent biliary events prior to cholecystectomy was identified. A recurrent biliary event was defined as a subsequent admission for AP (ICD-10, K85), biliary colic (K80), cholecystitis (K81), or cholangitis (K83.0) as a primary diagnosis after first admission from AP.…”

Section: Definitions Of Variablesmentioning

confidence: 99%

The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis

Cho

Scragg

Petrov

2021

HPB

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Section: Definitions Of Variablesmentioning

confidence: 99%

The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis

Cho

Scragg

Petrov

2021

HPB

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“…To achieve a better understanding of which facets of care impact LOS, the patient's hospital journey can be divided into its constituent parts. Doing so allows for a deeper understanding of pinch points that adversely impact the patient journey, especially in the context of earlier work showing that changes in departmental practice can result in significant increases in perioperative efficiency and improve patient outcomes without increases in funding 18,19 . The aim of the current study was to use a process informed approach to identify factors impacting the time to theater, intraoperative time, and time to discharge as the constituents of LOS and integrate these factors into a theorized perioperative management protocol 2 …”

Section: Introductionmentioning

confidence: 99%

Standardizing process in acute biliary disease

Tranter‐Entwistle,

Eglinton,

Connor

2023

World j. surg.

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IntroductionThe perioperative management of biliary disease (BD) is variable across institutions with suboptimal outcomes for patients and health care systems. This results in inefficient utilization of limited resources. The aim of the current study was to identify modifiable factors impacting patients' time to theater, intraoperative time, and time to discharge as the constituents of length of stay to guide creation of a perioperative management protocol to address this variability.MethodsData were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge.ResultsFour thousand five hundred seventy‐seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement.ConclusionsStandardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.

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“…3,4 The management of acute cholecystitis in New Zealand is changing, with an increasing number of IC performed, especially in metropolitan centres. 5,6 In many regional centres, challenges remain for IC, such as acute list availability, surgeon experience, support services and policy on clinical management. [6][7][8] Investigating the cost of IC may support its implementation in clinical practice in regional centres.…”

Section: Introductionmentioning

confidence: 99%

Cost analysis of index versus delayed cholecystectomy for acute cholecystitis in a New Zealand Provincial Centre

Srikumar

McGuinness

Kau

et al. 2022

ANZ Journal of Surgery

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Background: Evidence suggests index cholecystectomy (IC) in patients with acute cholecystitis is safe, has decreased hospital stay and is cheaper than delayed cholecystectomy (DC). Costs of cholecystectomy have not previously been investigated in New Zealand. The aim of this study was to compare cost of IC with DC for patients with acute cholecystitis. Methods: A retrospective analysis of adults admitted to Northland hospitals with acute cholecystitis between 1 January 2015 and 31 December 2019 who underwent subsequent cholecystectomy, was performed. Actual patient-level costs were utilized for cost comparison between IC and DC. Factors associated with increased costs were assessed using multivariate analysis. Results: Two hundred and eleven patients were included in the study; 72 (34%) underwent IC and 139 (65%) DC. There was no significant difference in total cost for IC ($12 767) versus DC ($12 029) (p = 0.192); this persisted on multivariate analysis. Patients having IC had more severe cholecystitis, and 90-day representation rate following DC was 35%. Costs were increased by severity of cholecystitis, age, American Society of Anesthesiology score (ASA) and travel distance. Conclusion: This study showed there is no significant difference in cost between IC and DC for patients with acute cholecystitis in Northland, New Zealand. Severity, increasing age, ASA and travel distance were drivers of costs. To recognize the cost benefits of IC, it is likely that increased rates of IC are needed.

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Index cholecystectomy for management of acute gallstone disease: a change of practice at a major New Zealand metropolitan centre

Cited by 6 publications

References 20 publications

The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis

The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis

Standardizing process in acute biliary disease

Cost analysis of index versus delayed cholecystectomy for acute cholecystitis in a New Zealand Provincial Centre

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