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Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease. an ESTES ‘snapshot audit’ of practice.pdf (824.72 kB)

Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES ‘snapshot audit’ of practice

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posted on 2024-05-09, 15:11 authored by Gary Alan Bass, Amy Gillis, Yang Cao, Shahin Mohseni, European Society for Trauma, Emergency Surgery (ESTES) Cohort Studies Group, Arnold HillArnold Hill, Dara KavanaghDara Kavanagh

Background: Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level.

Aim: To identify, through an international prospective nonrandomized cohort study, the epidemiology and areas of practice variability in management of acute complicated calculous biliary disease (ACCBD) and to correlate them against reported outcomes.

Methods: A preplanned analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Complicated Biliary Calculous Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. All eligible patients with acute complicated biliary calculous disease were recorded contemporaneously using a standardized predetermined protocol and a secure online database and followed-up through to 60 days from their admission.

Endpoints: A two-stage data collection strategy collecting patient demographics, details of operative, endoscopic and radiologic intervention, and outcome metrics. Outcome measures included mortality, surgical morbidity, ICU stay, timing of operative intervention, and length of hospital stay.

Results: Three hundred thirty-eight patients were included, with a mean age of 65 years and 54% were female. Diagnosis at admission were: cholecystitis (45.6%), biliary pancreatitis (21%), choledocholithiasis with and without cholangitis (13.9% and 18%). Index admission cholecystectomy was performed in just 50% of cases, and 28% had an ERCP performed. Morbidity and mortality were low.

Conclusion: This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich 'real world' insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study.

Funding

Open access funding provided by Örebro University

History

Comments

The original article is available at https://link.springer.com/

Published Citation

Bass GA, Gillis A, Cao Y, Mohseni S, European Society for Trauma, Emergency Surgery (ESTES) Cohort Studies Group. Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES 'snapshot audit' of practice. Eur J Trauma Emerg Surg. 2022;48(1):23-35.

Publication Date

7 July 2020

PubMed ID

32632631

Department/Unit

  • Beaumont Hospital
  • Surgery
  • Surgical Affairs

Research Area

  • Surgical Science and Practice
  • Cancer

Publisher

Springer Heidelberg

Version

  • Published Version (Version of Record)