Thursday, October 02, 2003

DB links to this paper (full article free!!) in the Canadian Medical Association Journal about the risk of emergent cholecystectomy while waiting for elective cholecystectomy. The conclusion from the abstract reads:
The probability that a patient on a waiting list will be admitted for emergency cholecystectomy consistently increases with the duration of wait, particularly after 20 weeks.
The median length of stay on the list was six weeks, but some patients waited for up to a year. I've never had an attack of biliary colic, but I don't think I would want to wait six, twenty, or fifty weeks to get my bag out. (My patients usually get theirs out 5-10 days after they see me)
Two things:
The criteria for inclusion seem to be onset of cholecystitis:
Surgeons on call made the decision to operate on patients who presented to the emergency department by evaluating (a) the clinical presentation for symptoms of increased pain or fever and signs of persisting or worsening abdominal tenderness, guarding or rebound or (b) the ultrasonographic finding of a thick-walled gallbladder with pericholecystic fluid or a positive finding of hepatobilary iminodiacetic acid on radionuclide scan or (c) both (a) and (b).
They make no mention of biliary pancreatitis, or common bile duct obstruction as being indicators for admission.
The other: They tried to remove them via the laparoscope initially, but opened them if the dissection was unsafe. It would be interseting to compare conversion rates (lap to open) to wait list time
In their conclusion they describe other conditions that may require emergency surgery on while on the waiting list:
.....include inguinal hernia, spinal cord conditions, abdominal aortic aneurysm or the need for coronary artery bypass grafting.....
The emergent AAA repair alone carries a fifty percent mortaility (if ruptured)
This study shows how an outpatient procedure can be turned in to easily 4-5 days in the hospital with the usual increase of expense. Talk about being penny wise and pound foolish.
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