title: Cholecystectomy following acute presentation to a major New Zealand metropolitan hospital: change to the timing of surgery is needed.
abstract: OBJECTIVE
  To review the management and outcome of patients presenting with acute biliary pain/cholecystitis, mild acute pancreatitis, or cholangitis to a major New Zealand (NZ) metropolitan hospital.
  
  
  METHODS
  A retrospective case note review was performed for all patients admitted acutely to Christchurch Public Hospital between 1 February 2005 and 31 September 2005, with the diagnosis of acute biliary pain/acute cholecystitis, acute pancreatitis, or cholangitis. Basic demographics, inpatient management, and subsequent outcome were recorded.
  
  
  RESULTS
  Sixty-eight (65%) patients were admitted with acute biliary pain/cholecystitis, 23 (22%) with mild acute pancreatitis, and 13 (13%) with cholangitis. Twelve of 81 (15%) patients (who were suitable for index cholecystectomy) underwent surgery, including only 3 of the 18 patients with mild acute pancreatitis. In the remaining 69 (85%) patients, who were eligible but did not undergo cholecystectomy at the index admission, 29 (42%) subsequently represented to the emergency department. Forty-eight (70%) patients required further inpatient admission related to gallstone-related pathology within the study period. Subsequently, 42 (61%) of the 69 patients treated conservatively underwent cholecystectomy at a median (range) of 70 (1-195) days from index admission, including 6 emergency cholecystectomies due to re-presentation
  
  
  CONCLUSIONS
  The management of acute gallstone-related disease at a major NZ metropolitan hospital fails to meet with current international standards. Few patients undergo index cholecystectomy, and a large proportion of those treated conservatively return to the health sector with ongoing problems.
authors.affiliation: Christchurch School of Medicine and Health Sciences, University of Otago.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lin
authors.forename: Peter
authors.initials: P
authors.lastname: Stiven
authors.forename: Philip
authors.initials: P
authors.lastname: Bagshaw
authors.forename: Saxon
authors.initials: S
authors.lastname: Connor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000209:etiology / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists