title: Emergency Management of Gallbladder Disease: Are Acute Surgical Units the New Gold Standard?
abstract: BACKGROUND
  Since 2011, all acute general surgical admissions have been managed by the consultant-led emergency general surgery service (EGS) at our institution. We aim to compare EGS management of acute biliary disease to its preceding model.
  
  
  METHODS
  Retrospective review of prospectively collated databases was performed to capture consecutive emergency admissions with biliary disease from 1st February 2009 to 31st January 2013. Patient demographics, surgical intervention, use of diagnostic radiology, histological diagnosis, complications and hospital length of stay (LOS) were retrieved.
  
  
  RESULTS
  A total of 566 patients were included (pre-EGS 254 vs. EGS 312). In the EGS period, the number of patients having surgery on index admission increased from 43.7 to 58.7 % (p < 0.001) as did use of intra-operative cholangiography from 75.7 to 89.6 % (p = 0.003). The conversion to open cholecystectomy rate also was reduced from 14.4 to 3.3 % (p < 0.001). Overall, a 14 % reduction in use of multiple (>1) imaging modalities for diagnosis was noted (p = 0.003). There was a positive trend in reduction of bile leaks but no significant difference in the overall morbidity and mortality. Time to theatre was reduced by 1 day [pre-EGS 2.7 (IQR 1.5-5.0) vs. EGS 1.7 (IQR 1.2-2.6) p < 0.001]. The overall hospital LOS was reduced by 1.5 days [pre-EGS 5.0 (IQR 3-7) vs. EGS 3.5 (IQR 2-5) p < 0.001].
  
  
  CONCLUSIONS
  Since the advent of EGS, more judicious use of diagnostic radiology, reduced complications, reduced LOS, reduced time to theatre and an increased rate of definitive management during the index admission were demonstrated.
authors: Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 2 East, 300 Grattan St, Parkville, VIC, 3050, Australia. shakerian.rose@gmail.com.|Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Level 6, Clinical Sciences Building, 300 Grattan St, Parkville, VIC, 3050, Australia. shakerian.rose@gmail.com.
authors: Rose
authors: R
authors: Shakerian
authors: Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 2 East, 300 Grattan St, Parkville, VIC, 3050, Australia.|Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Level 6, Clinical Sciences Building, 300 Grattan St, Parkville, VIC, 3050, Australia.
authors: Anita
authors: A
authors: Skandarajah
authors: Melbourne EpiCentre, Centre for Clinical Epidemiology, Biostatistics and Health Services Research, The Royal Melbourne Hospital, University of Melbourne and Melbourne Health, 7 East, Main Building, Grattan Street, Parkville, VIC, 3050, Australia.
authors: Alexandra
authors: A
authors: Gorelik
authors: Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 2 East, 300 Grattan St, Parkville, VIC, 3050, Australia.|Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Level 6, Clinical Sciences Building, 300 Grattan St, Parkville, VIC, 3050, Australia.
authors: Benjamin
authors: B
authors: Thomson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies