Trauma and acute care surgery at elliot hospital

Trauma & Acute Care Surgery at Elliot Hospital

Acute Care Surgical Facts:

1. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. (J Surg Res 2013 Oct;184(2):723-9)

2. Antibiotic administration can be an independent risk factor for therapeutic delay of pediatric acute appendicitis. Pediatr Emerg Care.2012 Aug;28(8):792-5.

3. In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg. 2011 Jul;35(7):1626-33. Delay>12 h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P=0.010) whereas a delay of 6 or 9 h was not.

4. Effect of delay to operation on outcomes in adults with acute appendicitis. Arch Surg. 2010 Sep;145(9):886-92. Delay to OR > 12 hours may result in longer hospital stays

5. Antibiotics versus appendectomy for uncomplicated appendicitis. HealthPACT Horizon Scanning 2013. Antibiotic management alone for uncomplicated appendicitis may be safe but recommendations on selective use do not yet exist. Concern for recurrence of appendicitis exists.

Based on evidence from only one high-bias risk trial, it appears that early laparoscopic cholecystectomy (less than 24 hours after diagnosis of biliary colic) decreases the morbidity during the waiting period for elective laparoscopic cholecystectomy (mean waiting time 4.2 months), the hospital stay, and operating time. Gurusamy KS, Koti R, Fusai G, Davidson BR. Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic. Cochrane Database of Systematic Reviews 2013, Issue 6.

The acute care surgery model accomplished earlier treatment and shorter length of stay for acute cholecystitis and acute appendicitis. Cubas RF, Gómez NR, Rodriguez S, Wanis M, Sivanandam A, Garberoglio CA.Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost. J Am Coll Surg. 2012 Nov;215(5):715-21.

laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs.

Gutt CN, Encke J, Köninger J, Harnoss JC, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013 Sep;258(3):385-93 Cholecystectomy for acute cholecystitis in elderly patients should be performed during initial hospitalization to prevent recurrent episodes of cholecystitis Riall TS, Zhang D, Townsend CM Jr, Kuo YF, Goodwin JS. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg. 2010 May;210(5):668-77,677-9.

In high-risk patients, percutaneous drainage and emergency cholecystectomy are both efficient in the resolution of acute cholecystitis sepsis. However, surgery is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible. Melloul E, Denys A, Demartines N, Calmes JM, Schäfer M. Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg. 2011 Apr;35(4):826-33.