Planned Early Discharge–Elective Surgical Readmission Pathway for Patients With Gallstone Pancreatitis

Clarke, Tatyan; Sohn, Helen J.; Kelso, Rebecca; Petrosyan, Mikael; Towfigh, Shirin; Mason, Rodney J.

doi:10.1001/archsurg.143.9.901

Cited by 14 publications

(7 citation statements)

References 28 publications

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“…This may reflect the lack of available operating time on routine lists together with poor prioritisation. On the other hand, this and other observational studies 18,24 have shown that the LOS during the index admission increases if patients undergo definitive treatment during that admission. It may be necessary to book patients with mild GSP for a cholecystectomy once the diagnosis has been made, even if they are still settling, as this has been shown to be safe and reduce LOS 25,26 .…”

Section: Discussionmentioning

confidence: 52%

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Definitive management of gallstone pancreatitis in England

El-Dhuwaib¹,

Deakin²,

David³

et al. 2012

Ann R Coll Surg Engl

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INTRODUCTIONThe aim of this study was to investigate whether definitive treatment of gallstone pancreatitis (GSP) by either cholecystectomy or endoscopic sphincterotomy in England conforms with British Society of Gastroenterology (BSG) guidelines and to validate these guidelines.METHODSHospital Episode Statistics data were used to identify patients admitted for the first time with GSP between April 2007 and April 2008. These patients were followed until April 2009 to identify any who underwent definitive treatment or were readmitted with a further bout of GSP as an emergency.RESULTSA total of 5,454 patients were admitted with GSP between April 2007 and April 2008, of whom 1,866 (34.2%) underwent definitive treatment according to BSG guidelines, 1,471 on the index admission. Patients who underwent a cholecystectomy during the index admission were less likely to be readmitted with a further bout of GSP (1.7%) than those who underwent endoscopic sphincterotomy alone (5.3%) or those who did not undergo any form of definitive treatment (13.2%). Of those patients who did not undergo definitive treatment before discharge, 2,239 received definitive treatment following discharge but only 395 (17.6%) of these had this within 2 weeks. Of the 505 patients who did not undergo definitive treatment on the index admission and who were readmitted as an emergency with GSP, 154 (30.5%) were admitted during the 2 weeks immediately following discharge.CONCLUSIONSFollowing an attack of mild GSP, cholecystectomy should be offered to all patients prior to discharge. If patients are not fit for surgery, an endoscopic sphincterotomy should be performed as definitive treatment.

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Section: Discussionmentioning

confidence: 52%

“…One study found that 31% of recurrent GSP occurred in the first two weeks following discharge 17 . In another study when patients were discharged home but operated on within two weeks this figure was 6.5% 18 . This further study also suggested that performing definitive treatment during the index admission increases the length of hospital stay (LOS).…”

mentioning

confidence: 95%

Definitive management of gallstone pancreatitis in England

El-Dhuwaib¹,

Deakin²,

David³

et al. 2012

Ann R Coll Surg Engl

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“…one of these studies, done in 2003, showed a 20% rate of recurrence in those patients who were managed with cholecystectomy more than 2 weeks after onset of pancreatitis (8). Although most prospective data is poorly powered, and sparse, there are a handful of small prospective studies that have also confirmed that for mild disease, early cholecystectomy is beneficial compared to delaying surgery beyond 2 weeks (10,11). one study even showed that the reduction in recurrences made early cholecystectomy cost effective (12).…”

Section: Mild Pancreatitsmentioning

confidence: 99%

Cholecystectomy for Acute Gallstone Pancreatitis: Early Vs Delayed Approach

Wilson

Moya

2010

Scand J Surg

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Background and Aims: the management of gallstone pancreatitis, in particular timing of cholecystectomy, has evolved substantially over the last decade. the trend has been toward earlier cholecystectomy. We review current literature regarding the timing of cholecystectomy in the context of gallstone pancreatitis. Materials and Methods: the authors performed a literature search in pubmed for relevant articles in the english language with greatest weight given to prospective trials compared to observational studies and previous reviews. Results: the literature search yielded 59 articles discussing cholecystectomy in the context of gallstone pancreatitis. most were retrospective studies or reviews, but there were nine prospective observational studies and two randomized control trials. for mild gallstone pancreatitis, laparoscopic cholecystectomy within 48 hours of presentation (without normalization of pancreatic enzymes or absence of abdominal pain) has been shown to shorten hospital stay without increased morbidity or mortality. routine preoperative erCp is unnecessary for patients with mild disease. for more severe disease, timing of cholecystectomy is governed by clinical status. interval cholecystectomy (>2 weeks after index admission) can be safely done with low risk of recurrence if the patient has had erCp and sphincterotomy at index admission. Conclusion: patients with mild gallstone pancreatitis should have cholecystectomy during index admission within 48 hours of arrival, but patients with more severe disease will require cholecystectomy at a later time, depending on the clinical circumstances. sphincterotomy should be done as soon as possible if cholecystectomy is not feasible early in course.

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“…1,2 It is a bundle of "best evidence-based practices" delivered by a multi-professional health care team, with the intention of assisting patients to recuperate expeditiously after surgery. 1 Clinical, or critical, pathways have been described to improve outcomes in various fields of surgery, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] including colorectal surgery. [17][18][19][20][21][22][23] Clinical pathways designed for the colorectal surgery patient have resulted in decreased hospital length of stay (LOS); decreased cost; and decreased, or no difference, in morbidity rates when compared to conventional care.…”

Section: Introductionmentioning

confidence: 99%

Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines

et al. 2022

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Objectives: This study aims to evaluate surgical outcomes (i.e. length of stay (LOS), 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the ERAS pathway, and determine its association with the rate of compliance to the different ERAS components. Methodology: This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then retrospectively compared to outcomes prior to the implementation of ERAS. Results: A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92% (SR:91.75%, CR:93.06%, RR:90.65%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.06 ± 6.67 vs 10.02 ± 5.43 days; p=0.002) and RR (19.85 ± 11.38 vs 16.85 ± 10.45 days; p=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar. Conclusion: Increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.

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Planned Early Discharge–Elective Surgical Readmission Pathway for Patients With Gallstone Pancreatitis

Cited by 14 publications

References 28 publications

Definitive management of gallstone pancreatitis in England

Definitive management of gallstone pancreatitis in England

Cholecystectomy for Acute Gallstone Pancreatitis: Early Vs Delayed Approach

Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines

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