Timely cholecystectomy for acute gallstone disease: an ongoing challenge in a New Zealand provincial centre.

The New Zealand medical journal 01/2014; 127(1392):48-57.
Source: PubMed

ABSTRACT To review the prior management of patients who underwent cholecystectomy for gallstone disease at a provincial centre over a 1-year period, with a particular focus on potentially preventable morbidity by performing index cholecystectomy (IC).
Retrospective case note review was performed for patients who underwent cholecystectomy at Hawke's Bay's hospitals between 1 March 2009 and 1 March 2010.
148 cholecystectomies were performed over the study period. Ninety-one patients (61%) were admitted acutely prior to receiving cholecystectomy. The IC rate was 15%. Seventy-seven patients who were admitted acutely could have been suitable for IC, but were discharged. These 77 patients subsequently had an additional 17 readmissions (72 bed-days), 26 ED presentations and 51 outpatient clinic (OPC) visits prior to receiving their eventual operation. Ten patients (13%) developed a complication or recurrence of their acute gallstone disease whilst awaiting surgery.
Hawke's Bay has a low rate of IC and fails to meet current international standards for timely surgical management of acute gallstone disease. A large proportion of those not operated on during their index admission re-present with further morbidity. There are significant barriers to improving these standards in a provincial centre with limited acute surgical resources.