Post-operative telephone review is safe and effective: prospective study - Monash outpatient review by phone trial.

INTRODUCTION: Studies have shown that post-operative telephone follow-up is satisfactory and effective. As high quality evidence is scant, we conducted a randomized controlled trial to compare it against outpatient clinic review for emergency laparoscopic appendicectomy or cholecystectomy. METHOD: Patients who received emergency laparoscopic appendicectomy or cholecystectomy were eligible for this study. Once recruited, they were randomly allocated to either clinic review or telephone follow-up on discharge. Participants were reviewed at 2 weeks after operation and contacted again at 4 weeks after initial follow-up for satisfaction survey. RESULTS: One hundred and seventy-nine participants were recruited with one withdrawn consent and six excluded. Ninety-six underwent laparoscopic appendicectomy and 76 had laparoscopic cholecystectomy. Ninety-six attended clinic review and 76 had telephone follow-up. The two groups were similar in baseline variables. Non-attendance rate was higher for clinic review cohort (24% vs 6.6%, P = 0.002). Participants who received telephone review reported higher satisfaction level (9.31 vs 8.85, P = 0.002), and most patients prefer telephone follow-up (73.1%, P < 0.0001). No difference was detected for missed complications (P = 0.354). CONCLUSION: Telephone follow-up post laparoscopic appendicectomy or cholecystectomy is safe, satisfying and effective.

Is early colonoscopy after CT-diagnosed diverticulitis still necessary?

PURPOSE: WHO GLOBOCAN 2012 data showed that Australia and New Zealand have the highest incidence rates of colorectal cancer in the world (Ferlay et al. 1). Current guidelines recommend that patients admitted for an episode of acute diverticulitis require an early follow-up colonoscopy to rule out colorectal malignancy as reported by Fozard et al. (Colorectal Dis 13:1-11, 2011). Recent studies however have indicated that this may not be warranted (Brar et al. Dis Colon rectum 56:1259-1264, 2013). This study aimed to review the current practice by looking at our institution's rate of colorectal malignancy diagnosed after an episode of acute diverticulitis. METHODS: We conducted a retrospective analysis of patients who presented with acute diverticulitis at our institution between 2011 and 2013. Included in the study were patients who received follow-up colonic evaluation in the next 12 months after admission. Patients who had a colonoscopy in the last year prior to emergency presentation were excluded. The primary outcome measure was the incidence of histologically confirmed colorectal carcinoma diagnosed on follow-up colonoscopy. Secondary outcome measures were incidence of low-grade or advanced adenoma on follow-up colonic evaluation. RESULTS: A total of 523 cases of acute diverticulitis were diagnosed on CT scan. Out of 351 patients with uncomplicated diverticulitis, 196 had follow-up colonoscopy, with one case of colorectal malignancy recorded. Low-grade and advanced adenomas were found on 10.7 and 2.0% of colonoscopies performed respectively in this subgroup. Seventy-four out of 172 patients with complicated diverticulitis had follow-up evaluation, with four cases of colorectal malignancy discovered. Low-grade and advanced adenomas were found on 6.75 and 5.41% of colonoscopies performed respectively in this subgroup. CONCLUSION: Routine interval colonoscopy following an episode of conservatively managed uncomplicated diverticulitis may not be necessary. Interval colonoscopy is still indicated in patients with complicated diverticulitis. Further collaborative study across different institutions may be warranted to gain better statistical significance.

Outcomes of patients with appendicitis who present to an outer metropolitan hospital.

BACKGROUND: The present study investigates patients with acute appendicitis who presented to a hospital with no acute surgical service (group A) and compares the outcomes of these patients with those that presented to a tertiary centre with an acute surgical service within the same health network (group B). All group A patients were transferred to the group B hospital for appendicectomy. METHODS: During a 10-month period, 257 patients (80 in group A, 177 in group B) with acute appendicitis were analysed retrospectively. Demographics, emergency department parameters, time to waiting bay, time to surgery, operative time, complications, length of stay and the stage of appendicitis were all noted for each group. A comparison of each of these parameters was made between the two groups of patients. RESULTS: There were 80 patients in group A and 177 patients in group B. There was a significant difference between the two groups in the fields of length of stay in the emergency department (P = 0.003), bed availability (P = 0.038), time to waiting bay (P = 0.006) and time to surgery (P = 0.006). There was no significant difference in the total length of stay and complication rates between the two groups (P = 0.58 and 0.78, respectively). CONCLUSION: This study concludes that patients with acute appendicitis presenting to a hospital with no acute surgical services had a greater waiting period prior to surgery. However, this did not translate into greater complication rates or length of stay for these patients. We propose a prospective study to further analyse the outcomes in such patients.