Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

• DOI: 10.1111/ans.14898
• Publication Date: 2018-11-10T06:21:03Z
• Authors: Daniel R. A. Cox; Jonathan Fong; Chon Hann Liew; Su Kah Goh; Michael Yeoh; Michael A. Fink; Robert M. Jones; Jude Mukkadayil; Mehrdad Nikfarjam; Marcos V. Perini; Greg Rumler; Graham Starkey; Chris Christophi; Vijayaragavan Mur...
• Keywords: Biliary colic; Biliary disease

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 outcome implementing a policy to offer laparoscopic cholecystectomy on index with colic in tertiary Australia. Methods This retrospective cohort study adult presenting emergency department (ED) during three 12‐month periods. Outcomes Group A, 3 years prior implementation, were compared groups 2 7 post implementation (Groups B C). Primary outcomes representations ED, admission rate time cholecystectomy. Results A total 584 presented Of these, 391 underwent Strasberg Type bile leaks no duct injuries. The increased rates (A = 15.8%, 62.9%, C 29.5%, P < 0.001) surgery 12.0%, 60.7%, 27.4%, 0.001). There was decline (days) 143, 15, 31, 0.001), post‐operative length stay 3.6, 3.2, 2.0, 0.05) representation ED 42.1%, 7.1%, 19.9%, adherence later cohort. Conclusion Index for decrease patient representations, surgery, complications demonstrates impact initial improvement, dangers attrition need continued reinforcement.