Emergency Laparoscopic Cholecystectomy: Is Dedicated Hot Gall Bladder List Cost Effective?

BACKGROUND: Acute presentation of gall stone disease is a common emergency. Resource limitation often results in unnecessary long waiting times and repeat hospital admissions. The aim of this study was to investigate if funding a dedicated hot gall bladder list is justified. METHODS: Patients with acute gall stone related complications between 1st January 2016 and 31st December 2017 were studied. Outcome measures included the number of acute admissions, length of hospital stay (LOS), approximate cost per patient. The length of stay was identified as a critical outcome measure. RESULTS: Fourteen hundred and ninety-five (11%) out of 14189 acute surgical admissions were related to gall stone complications. These included acute cholecystitis 576 (39%), biliary colic 485 (32%), pancreatitis 405 (27%) and jaundice 34 (2%). Twelve hundred and twenty-two patients accounted for 1461 admissions. 182 (15%) patients had recurrent admissions (35%) and on average stayed 11.2 days in the hospital compared to 5.8 days for that of single presentation. The cost of emergency LC (£2053) was less than half of elective LC following single emergency admission (£5661) and less than one third of Elective LC following recurrent admissions (£7453). A trust can save £1,891,784 per year by achieving 80% target. The savings can be used to fund a dedicated hot gall bladder list, releasing hospital beds and additional benefit of reducing the workforce days lost to sickness in general. CONCLUSIONS: Emergency LC is cost effective and savings made for such a service is sufficient to fund a dedicated hot gall bladder list..

Do Serum Acute Phase Reactants Predict Clinical Outcome In Emergency General Surgical Admissions?

BACKGROUND: Identifying general surgical patients at risk of poor outcome can be a diagnostic challenge. This study aimed to determine the significance of admission serum acute phase reactants in predicting emergency general surgical outcome. METHODS: An electronic database containing all acute general surgical admissions over two years was analysed to correlate admission acute phase reactants (including C-reactive protein (CRP), absolute neutrophil count (ANC) and serum albumin) with outcome. Study endpoints included: cross-sectional imaging, surgery, intensive care admission, in-hospital mortality and length-of-stay (LOS). RESULTS: A total of 9738 patients were enrolled in the study. Elevated CRP (n= 4635; 47%) was associated with: advanced imaging 17% vs 30% (p=0.0001), surgery 15% vs 28% (p=0.0001), ITU admission 3% vs 7% (p=0.0001) and mortality 0.5% vs 2% (p=0.0001). A cut-off level of >150 mg/L was most significant. Abnormal ANC (n= 4104; 42%) was significant in predicting advanced imaging 15% vs 55% (p=0.0001), surgery 17% vs 27% (p=0.0001), and ITU admission 3% vs 8% (p=0.0001). Hypoalbuminaemia (n= 1392; 14%) was associated with a 12-fold rise in mortality 0.5% vs 6%. Normal CRP, ANC with hypoalbuminaemia was a strong negative predictor of mortality (0.015% vs 1.24%), while an abnormal combination was associated with mortality of 8%. CONCLUSIONS: Admission acute phase reactants are useful to enhance acute surgical patient stratification during clinical decision making. An admission CRP above 150 should alert the clinician of a potentially high-risk patient who may require prompt intervention. A combination of abnormal results has the highest in-hospital mortality.