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Timely cholecystectomy for acute gallstone disease: an ongoing challenge in a New Zealand provincial centre
Melissa J Welch, Andrew R Moot1
1Department of General Surgery, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand. armoot@yahoo.com.
Insights
Provincial hospitals have a low rate of index cholecystectomy (IC) for gallstone disease, leading to patient readmissions and complications. Improving timely surgical management requires addressing resource limitations in these centers.
Area of Science:
- Surgical Management
- Gastroenterology
- Public Health
Background:
- Gallstone disease necessitates timely surgical intervention, often cholecystectomy.
- Index cholecystectomy (IC) aims to manage acute gallstone disease during the initial hospital admission.
- Provincial centers face unique challenges in delivering timely surgical care.
Purpose of the Study:
- To evaluate the management of patients undergoing cholecystectomy for gallstone disease.
- To assess the rate of potentially preventable morbidity associated with delayed surgery.
- To focus on the index cholecystectomy (IC) rate at a provincial hospital.
Main Methods:
- A retrospective review of patient case notes was conducted.
- Data were collected for all cholecystectomies performed over a one-year period.
- Focus was placed on patients admitted acutely for gallstone disease.
Main Results:
- 148 cholecystectomies were performed; 61% of patients were admitted acutely.
- The index cholecystectomy (IC) rate was 15%, with 77 suitable patients discharged without surgery.
- Delayed surgery resulted in 17 readmissions, 26 ED presentations, and 51 outpatient visits for these patients.
Conclusions:
- The provincial center's IC rate is low, falling short of international standards for acute gallstone disease management.
- Patients not operated on during their index admission experienced significant recurrent morbidity.
- Limited surgical resources in provincial settings pose barriers to improving timely surgical care standards.
Aims:
To review the prior management of patients who underwent cholecystectomy for gallstone disease at a provincial centre over a 1-year period, with a particular focus on potentially preventable morbidity by performing index cholecystectomy (IC).
Methods:
Retrospective case note review was performed for patients who underwent cholecystectomy at Hawke's Bay's hospitals between 1 March 2009 and 1 March 2010.
Results:
148 cholecystectomies were performed over the study period. Ninety-one patients (61%) were admitted acutely prior to receiving cholecystectomy. The IC rate was 15%. Seventy-seven patients who were admitted acutely could have been suitable for IC, but were discharged. These 77 patients subsequently had an additional 17 readmissions (72 bed-days), 26 ED presentations and 51 outpatient clinic (OPC) visits prior to receiving their eventual operation. Ten patients (13%) developed a complication or recurrence of their acute gallstone disease whilst awaiting surgery.
Conclusion:
Hawke's Bay has a low rate of IC and fails to meet current international standards for timely surgical management of acute gallstone disease. A large proportion of those not operated on during their index admission re-present with further morbidity. There are significant barriers to improving these standards in a provincial centre with limited acute surgical resources.
