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Title: Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute.
Austin Authors: Cox, Daniel R A ;Fong, Jonathan;Liew, Chon Hann;Goh, Su Kah ;Yeoh, Michael;Fink, Michael A ;Jones, Robert M ;Mukkadayil, Jude;Nikfarjam, Mehrdad ;Perini, Marcos V ;Rumler, Greg ;Starkey, Graham M ;Christophi, Christopher ;Muralidharan, Vijayaragavan 
Affiliation: Austin Health
Department of Hepato-Pancreatic-Biliary Surgery, Austin Health, Heidelberg, Victoria, Australia
Surgery (University of Melbourne)
Victorian Liver Transplant Unit
Issue Date: 9-Nov-2018
Publication information: ANZ Journal of Surgery 2018; 88 (12): 1337-1342
Abstract: BACKGROUND: Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic in a tertiary hospital in Australia. METHODS: This is a retrospective cohort study of adult patients presenting to the emergency department (ED) with biliary pain during three 12-month periods. Outcomes in Group A, 3 years prior to policy implementation, were compared with groups 2 and 7 years post implementation (Groups B and C). Primary outcomes were representations to ED, admission rate and time to cholecystectomy. RESULTS: A total of 584 patients presented with biliary colic during the three study periods. Of these, 391 underwent cholecystectomy with three Strasberg Type A bile leaks and no bile duct injuries. The policy increased admission rates (A = 15.8%, B = 62.9%, C = 29.5%, P < 0.001) and surgery on index presentation (A = 12.0%, B = 60.7%, C = 27.4%, P < 0.001). There was a decline in time to cholecystectomy (days) (A = 143, B = 15, C = 31, P < 0.001), post-operative length of stay (days) (A = 3.6, B = 3.2, C = 2.0, P < 0.05) and representation rates to ED (A = 42.1%, B = 7.1%, C = 19.9%, P < 0.001). There was a decline in policy adherence in the later cohort. CONCLUSION: Index hospital admission and cholecystectomy for biliary colic decrease patient representations, time to surgery, post-operative stay and complications of gallstone disease. This study demonstrates the impact of the policy with initial improvement, the dangers of policy attrition and the need for continued reinforcement.
DOI: 10.1111/ans.14898
ORCID: 0000-0002-5092-4370
Journal: ANZ Journal of Surgery
PubMed URL: 30414227
Type: Journal Article
Type of Clinical Study or Trial: Cohort Study
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