Retrospective Analysis of treatment of patients with Acute Cholecystitis by the General Surgery team at the RVI; should provision of Emergency General Surgery services change?

Jacob Begbie, Mohammed Fageer

Introduction
Gallstone related pathology (GD) accounts for a large proportion of general surgery acute admissions, with 3% of acute admissions due to acute cholecystitis (AC). Guidelines from NICE and AUGIS state that AC patients should be offered laparoscopic cholecystectomy (LC) within 7 days of diagnosis (ALC). Despite this, treatment of AC differs widely between hospitals and surgeons.

This analysis aimed to ascertain the rate of ALCs undertaken in those admitted with AC to the RVI; and compare if rates differed depending on the speciality of the admitting surgeon. 

Methods
Patients were identified using patient lists from on-call takes 01/08/2016 to the 31/07/2017. Online records were then used to gather data.  

Results
119 patients were admitted with confirmed AC. Of these 48 (40%) underwent LC within 7 days of admission (ALC); 31 (26%) received delayed laparoscopic cholecystectomy (DLC); and 40 (34%) received no surgical intervention (NLC). 38 patients were admitted under the care of an UGI surgeon, and 81 were admitted under either an endocrine of LGI surgeon (NUGI). 61% of UGI patients underwent ALC, as compared to 30% NUGI patients* (p=0.002). 14 patients (1 in 5) who did not receive ALC were readmitted to acute services with GD.

Discussion
These results are in keeping with previous research that management differs between hospitals / surgeons. Hospitals have previously had success improving their rate of ALCs by creating an Emergency Surgery Unit (ESU). Could creation of an ESU at the RVI improve patient outcomes and be of financial reward to the trust?