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Bridging the Gap: Comparison of Outpatient Clinic and Emergency Department Patients Undergoing Cholecystectomy.
Martin, W Taylor; Snyder, Katherine B; Stewart, Kenneth; Sarwar, Zoona; Starr, William C; Grady, Anna; Ball, Jonathan; Raines, Alexander R; Cross, Alisa.
Afiliação
  • Martin WT; Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma. Electronic address: whitney.martin@yale.edu.
  • Snyder KB; Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
  • Stewart K; Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
  • Sarwar Z; Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
  • Starr WC; The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
  • Grady A; The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
  • Ball J; The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
  • Raines AR; Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
  • Cross A; Department of Surgery, The University of Oklahoma, Oklahoma City, Oklahoma.
J Surg Res ; 300: 183-190, 2024 Aug.
Article em En | MEDLINE | ID: mdl-38823268
ABSTRACT

INTRODUCTION:

Literature shows failure of the outpatient clinic (OC) pathway after emergency department (ED) ultrasound diagnosis of symptomatic cholelithiasis (SC). We hypothesized SC to be more prevalent on final surgical pathology (FSP) in patients who successfully completed OC pathway.

METHODS:

This retrospective single-institution chart review compared OC and ED patients with right upper quadrant (RUQ) pain and cholelithiasis whom underwent cholecystectomy. Clinical evaluation was considered positive if RUQ pain >4 h, or + Murphy's sign. Ultrasound was positive if two of these three were present sonographic Murphy's, wall thickness > 4 mm, or pericholecystic fluid. Results were compared with FSP.

RESULTS:

Six hundred-seven patients underwent cholecystectomy, 299 OC and 308 ED. OC was more likely to SC (23% versus 4.6%) (P < 0.0001) and ED acute cholecystitis (39.3% versus 4.7%). Chronic cholecystitis was the most common FSP in both OC (72%) and ED (56%) populations, of these, 73% of OC denied pain >4 h versus only 10% of ED (P < 0.001). Median time from evaluation to cholecystectomy was 14 d versus 14 h in the OC and ED respectively (P < 0.0001).

CONCLUSIONS:

While chronic cholecystitis was the most common FSP in both OC and ED, the majority of OC reported RUQ pain <4 h delineating these presentations. Duration of pain should be utilized as algorithm triage. We recommend patients with pain episode <4 h should complete OC algorithm with expedited cholecystectomy within 14 d.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Colecistectomia / Colelitíase / Serviço Hospitalar de Emergência / Instituições de Assistência Ambulatorial Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Surg Res Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Colecistectomia / Colelitíase / Serviço Hospitalar de Emergência / Instituições de Assistência Ambulatorial Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Surg Res Ano de publicação: 2024 Tipo de documento: Article