Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore.
Eur J Trauma Emerg Surg. 2021 Oct;47(5):1535-1541. doi: 10.1007/s00068-020-01308-1. Epub 2020 Feb 4.
Early laparoscopic cholecystectomy (ELC) has shown to reduce length of stay and improve patients' satisfaction as compared to delayed laparoscopic cholecystectomy (DLC). However, logistics and manpower limitations often preclude ELC.
A retrospective study was conducted in a single institute to compare outcomes of AC before (August 2013-2014) and after (August 2017-2018) establishment of emergency surgery and trauma (ESAT).
There were 82 patients in pre-ESAT period and 172 patients in ESAT period. Mean age was 52.3 ± 11.6 and 55.7 ± 13.8 years, respectively, p = 0.369. There were more patients with moderate-severe grading of cholecystitis based on Tokyo Guidelines (TG 18) in ESAT 143/172 (83.1%) as compared to pre-ESAT 65/82 (79.3%), p = 0.042. Index cholecystectomy was performed in 145/172 (84.3%) of patients in the ESAT vs 34/82 (41.5%) of patients in the pre-ESAT period (p = 0.001). Time interval between booking to surgery was 180 ± 56 min in ESAT vs 197 ± 98 min in pre-ESAT, p = 0.014. Operative duration was shorter in ESAT 121 ± 38.5 min vs 139 ± 53.4, in pre-ESAT period, p = 0.030. Conversion rates were lower in ESAT (4/172, 2.3%) vs (9/72, 11%) in pre-ESAT, p = 0.003. Length of stay was shorter in ESAT (DLC 1.89 ± 1.6 and ELC ± 2.9 days) as compared to pre-ESAT (DLC 4.55 ± 2.2 and ELC 5.03 ± 2.6 days), p = 0.001. 30-day readmissions were lower in ESAT (3/172, 1.7%) vs pre-ESAT (8/72, 9.8%).
The ESAT model provided more early laparoscopic cholecystectomies with improved efficiency and clinical outcomes.
与延迟腹腔镜胆囊切除术（DLC）相比，早期腹腔镜胆囊切除术（ELC）已被证明可缩短住院时间并提高患者满意度。然而，物流和人力限制常常使 ELC 无法进行。
本研究在一家单中心进行了回顾性研究，比较了建立急症手术和创伤科（ESAT）前后（2013 年 8 月至 2014 年 8 月和 2017 年 8 月至 2018 年 8 月）的急性胆囊炎患者的结局。
ESAT 前组有 82 例患者，ESAT 后组有 172 例患者。ESAT 前组和 ESAT 后组的平均年龄分别为 52.3±11.6 岁和 55.7±13.8 岁，p=0.369。ESAT 后组基于东京指南（TG 18）的中度至重度胆囊炎患者比例（143/172，83.1%）高于 ESAT 前组（65/82，79.3%），p=0.042。ESAT 后组有 145/172（84.3%）例患者接受了指数胆囊切除术，而 ESAT 前组只有 34/82（41.5%）例患者接受了指数胆囊切除术（p=0.001）。ESAT 前组和 ESAT 后组的手术预约至手术的时间间隔分别为 180±56 分钟和 197±98 分钟，p=0.014。ESAT 后组的手术时间更短，为 121±38.5 分钟，而 ESAT 前组为 139±53.4 分钟，p=0.030。ESAT 后组的中转率（4/172，2.3%）低于 ESAT 前组（9/72，11%），p=0.003。ESAT 后组的住院时间更短，DLC 为 1.89±1.6 天，ELC 为 2.9 天，而 ESAT 前组的住院时间为 DLC 4.55±2.2 天，ELC 为 5.03±2.6 天，p=0.001。ESAT 后组的 30 天再入院率更低（3/172，1.7%），而 ESAT 前组的 30 天再入院率为 8/72（9.8%）。
ESAT 模式提供了更多的早期腹腔镜胆囊切除术，提高了效率和临床结局。
