Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis.
BACKGROUND
Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP).


METHODS
A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed.


RESULTS
Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001).


CONCLUSIONS
A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP.
London North West Healthcare NHS Trust , UK.
S
S
Bokhari
London North West Healthcare NHS Trust , UK.
M
M
Kulendran
London North West Healthcare NHS Trust , UK.
L
L
Liasis
London North West Healthcare NHS Trust , UK.
K
K
Qurashi
London North West Healthcare NHS Trust , UK.
M
M
Sen
London North West Healthcare NHS Trust , UK.
S
S
Gould
D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D042882:Gallstones / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology* / Q000601:surgery*; D015397:Program Evaluation
Cholecystectomy; Emergency surgery; Gallstones; Guidelines; Pancreatitis