Implementation of a specialist-led service for the management of acute gallstone disease.
BACKGROUND
The 'gold standard' treatment for acute cholecystitis and biliary colic requiring hospital admission is urgent laparoscopic cholecystectomy. This is not routinely available in all hospitals.


METHODS
A retrospective audit of emergency admissions with acute cholecystitis or biliary colic from January to December 2000 led to the development and implementation of a specialist-led protocol for the urgent management of acute gallstone disease. A second audit was carried out covering the 6 months after implementation.


RESULTS
One hundred and fifty-eight patients were admitted with acute cholecystitis or biliary colic in the first audit period and 110 in the second interval. The rate of cholecystectomy at index admission increased from 37.3 to 67.3 per cent, at a median of 3 days after admission, and the conversion rate to open surgery fell from 32 to 12 per cent. Median hospital stay fell from 9 to 5.5 days, and the unplanned readmission rate decreased from 19.0 to 3.6 per cent.


CONCLUSIONS
Urgent cholecystectomy for the management of acute gallstone disease is feasible and achievable in an acute services hospital with a specialist upper gastrointestinal team. It can lead to a reduced conversion rate, shorter hospital stay, fewer unplanned readmissions, an acceptable operating time and a low complication rate. The protocol is recommended for implementation in other hospitals.
Mercer
S J
SJ
Department of Upper Gastrointestinal Surgery, Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK.
Knight
J S
JS
Toh
S K C
SK
Walters
A M
AM
Sadek
S A
SA
Somers
S S
SS
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000601:surgery*; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D002764:Cholecystitis / Q000601:surgery; D002985:Clinical Protocols; D003085:Colic / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D004739:England; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011364:Professional Practice