Please use this identifier to cite or link to this item:
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, Heidelberg, Victoria, Australia
Department of Hepato-Pancreatic-Biliary Surgery, Austin Health, Heidelberg, Victoria, Australia
Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
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
PubMed URL: 30414227
Type: Journal Article
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 2, 2022

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.