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Lookup NU author(s): Venkatesh Kanakala
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Background: The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.Methods: Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structurewith patients (level 1) nestedwithin hospitals (level 2).Results: Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25.0 kg/m(2), who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0.52 (95 per cent c.i. 0.45 to 0.57). The predicted probabilities ranged from 0.02 to 0.95 across the 165 hospitals, demonstrating significant variation between hospitals.Conclusion: Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao ST, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Rodriguez DU, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Bajwa DS, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Iqbal LGN, Watson NF, Aggarwal SK, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, 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Grp, West Midlands Res Collaborative
Publication type: Article
Publication status: Published
Journal: British Journal of Surgery
Year: 2016
Volume: 103
Issue: 12
Pages: 1716-1726
Print publication date: 01/11/2016
Online publication date: 17/10/2016
Acceptance date: 06/07/2016
ISSN (print): 0007-1323
ISSN (electronic): 1365-2168
Publisher: John Wiley & Sons Ltd.
URL: http://dx.doi.org/10.1002/bjs.10288
DOI: 10.1002/bjs.10288
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