AI Article Synopsis

  • Gallstone disease significantly strains healthcare resources, particularly through emergency cholecystectomy, yet there's limited research on the risk factors that lead to such emergencies in patients scheduled for elective surgery.
  • A study conducted in Jeddah, Saudi Arabia, analyzed 823 patients, revealing that 15.67% underwent emergency cholecystectomy, often due to longer waiting times and previous emergency department visits.
  • Key findings indicated that patients with acute cholecystitis or pancreatitis, and those with multiple prior ED visits, are at a much higher risk of requiring emergency surgery.

Article Abstract

Background: Gallstone disease is one of the most resource-intensive surgical conditions. Despite the significant burden of emergency cholecystectomy on healthcare system, there is lack of research assessing the risk factors predisposing scheduled elective cholecystectomy patients to emergency surgery. Characterization of patients with gallstones helps to prioritize delivery of health care to avoid urgent surgery. The objective of the present study is to analyze risk factors associated with emergency cholecystectomy and assess the impact of delay on electively scheduled patients.

Methods: This retrospective cohort study at a tertiary care center in Jeddah, Saudi Arabia, between January 2018 and June 2022. Net total of 823 patients.The study has collected data retrospectively from an electronic health record system. The data were entered and coded in excel sheet. All statistical tests were 2-sided and were conducted using SAS statistical software version 9.4 (SAS Institute Inc. Cary, NC).

Results: A total of 823 patients met the inclusion criteria and enrolled in the analysis. Among them, 129 patients (15.67%) underwent emergency cholecystectomy, while 694 patients (84.33%) underwent elective cholecystectomy. The waiting time in days was significantly longer for patients undergoing emergency cholecystectomy (mean of 362 days) compared to those undergoing elective cholecystectomy (mean of 305 days). Patients with more than two previous ED visits were over five times more likely to undergo emergency cholecystectomy compared to those who had never visited the ED previously (p-value < 0.0001) Moreover, patients diagnosed with acute cholecystitis and pancreatitis were more likely to undergo emergency cholecystectomy compared to those not diagnosed with these conditions (p-value < 0.0001; p-value 0.02).

Conclusion: Analysis of risk factors and delay in patients with gallstones scheduled for elective cholecystectomy demonstrates that long waiting times, severity of the initial visit setting, Hemolytic anemia, and male gender were significantly related to emergency cholecystectomy. Independent risk factors for emergency cholecystectomy were frequency of ED visits, acute cholecystitis, pancreatitis, and CBD stone. Patients with these risk factors should be given priority on the waiting list to avoid emergency surgery. Future research is required to design a scoring system or specific criteria for elective patients at risk of developing acute cholecystitis.

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Source
http://dx.doi.org/10.1186/s12893-024-02694-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662557PMC

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Article Synopsis
  • Gallstone disease significantly strains healthcare resources, particularly through emergency cholecystectomy, yet there's limited research on the risk factors that lead to such emergencies in patients scheduled for elective surgery.
  • A study conducted in Jeddah, Saudi Arabia, analyzed 823 patients, revealing that 15.67% underwent emergency cholecystectomy, often due to longer waiting times and previous emergency department visits.
  • Key findings indicated that patients with acute cholecystitis or pancreatitis, and those with multiple prior ED visits, are at a much higher risk of requiring emergency surgery.
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Introduction Acute cholecystitis, commonly caused by gallstones, is a prevalent surgical emergency worldwide. Laparoscopic cholecystectomy (LC) is the gold standard for treatment, but the timing is crucial, with early surgery (within seven days) reducing complications. Identifying prognostic factors such as age, sex, white blood cell (WBC) count, C-reactive protein (CRP), and gallbladder wall thickness can help predict outcomes and reduce the need for conversion to open surgery.

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Background: Postoperative extubation is a critical phase. Various medications and different ventilation modes are employed during extubation to minimize potential issues. This study aimed to observe the early effects of the concurrent use of positive end-expiratory pressure (PEEP) and pressure support ventilation (PSV) modes during the extubation-emerge period on the respiratory system.

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Robotic cholecystectomy (RC) using the da Vinci surgical system has been introduced as a potential alternative to the gold standard laparoscopic cholecystectomy (LC) for gallbladder removal. This systematic review aims to evaluate and compare the postoperative outcomes (operative time, bile leak, and postoperative complications) and cost-effectiveness between da Vinci RC and LC. A comprehensive search of electronic databases, including EMBASE, MEDLINE, Cochrane Library, and PubMed, used Medical Subject Headings terms and Boolean operators to identify relevant studies.

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Predictors of failure of conservative management of cholecystitis: a systematic review of the literature.

ANZ J Surg

December 2024

Department of Upper Gastrointestinal, Hepatobiliary and Pancreatic Surgery, Westmead Hospital, Westmead, New South Wales, Australia.

Objectives: While emergency cholecystectomy is the preferred treatment for acute cholecystitis, conservative management can be used as a bridge to definitive surgical management in situations where emergency surgical services are limited. The objective of this systematic review is to identify factors associated with conservative management failure as defined as either failed resolution of symptoms on initial presentation, or the recurrence of symptoms whilst awaiting an elective cholecystectomy. This study aims to allow clinicians to make evidence-based recommendations for conservative versus operative management.

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