Early definitive treatment rate as a quality indicator of care in acute gallstone pancreatitis. BJS 2017; 104: 1686-1694.
Published: 9th August 2017
Authors: R. Green, S. C. Charman, T. Palser
Early definitive treatment (cholecystectomy or endoscopic sphincterotomy in the same admission or within 2 weeks after discharge) of gallstone disease after a biliary attack of acute pancreatitis is standard of care. This study investigated whether compliance with early definitive treatment for acute gallstone pancreatitis can be used as a care quality indicator for the condition.
A retrospective cohort study was conducted using the Hospital Episode Statistics database. All emergency admissions to National Health Service hospitals in England with a first time diagnosis of acute gallstone pancreatitis in the financial years 2008, 2009 and 2010 were examined. Trends in early definitive treatment between hospital trusts were examined and patient morbidity outcomes were determined.
During the study interval there were 19 510 patients with an overall rate of early definitive treatment at 34·7 (range 9·4–84·7) per cent. In the 1‐year follow‐up period, 4661 patients (23·9 per cent) had one or more emergency readmissions for complications related to gallstone pancreatitis. Of these, 2692 (57·8 per cent) were readmissions for acute pancreatitis; 911 (33·8 per cent) were within the first 2 weeks of discharge, with the remaining 1781 (66·2 per cent) occurring after the point at which definitive treatment should have been received. Early definitive treatment resulted in a 39 per cent reduction in readmission risk (adjusted risk ratio (
In acute gallstone pancreatitis, compliance with recommended early definitive treatment varied considerably, with associated variation in outcomes. Compliance should be used as a quality indicator to improve care.Full text
You may also be interested in
Neoadjuvant chemotherapy response influences outcomes in non‐colorectal, non‐neuroendocrine liver metastases.
Authors: A. M. Lucchese, A. N. Kalil, A. Ruiz, V. Karam, O. Ciacio, G. Pittau et al.
Notes: Multimodal therapy works
Authors: B. Groot Koerkamp, W. R. Jarnagin
Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. BJS 2018; 105: 1182-1191.
Authors: M. C. Halls, G. Berardi, F. Cipriani, L. Barkhatov, P. Lainas, S. Harris et al.
Notes: Helps improve selection for laparoscopic liver resection
Validation of at least 1 mm as cut‐off for resection margins for pancreatic adenocarcinoma of the body and tail. BJS 2018; 105: 1171-1181.
Authors: T. Hank, U. Hinz, I. Tarantino, J. Kaiser, W. Niesen, F. Bergmann et al.
Notes: Validated for R0
Meta‐analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. BJS 2018; 105: 946-958.
Authors: E. Versteijne, J. A. Vogel, M. G. Besselink, O. R. C. Busch, J. W. Wilmink, J. G. Daams et al.
Notes: Improved survival with neoadjuvant treatment
Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases. BJS 2018; 105: 1210-1220.
Authors: G. A. Margonis, K. Sasaki, S. Gholami, Y. Kim, N. Andreatos, N. Rezaee et al.
Notes: Predicts survival
Reappraisal of classification of distal cholangiocarcinoma based on tumour depth. BJS 2018; 105: 867-875.
Authors: H. Aoyama, T. Ebata, M. Hattori, M. Takano, H. Yamamoto, M. Inoue et al.
Notes: Better for T staging
Prediction of major complications after hepatectomy using liver stiffness values determined by magnetic resonance elastography. BJS 2018; 105: 1192-1199.
Authors: N. Sato, A. Kenjo, T. Kimura, R. Okada, T. Ishigame, Y. Kofunato et al.
Notes: liver stiffness predicts complications
Randomized clinical trial
Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy. BJS 2018; 105: 811-819.
Authors: M. Schindl, R. Függer, P. Götzinger, F. Längle, M. Zitt, S. Stättner et al.
Notes: Not effective in reducing complications
Prognostic impact of perihepatic lymph node metastases in patients with resectable colorectal liver metastases. BJS 2018; 105: 1200-1209.
Authors: M. Okuno, C. Goumard, T. Mizuno, S. Kopetz, K. Omichi, C.‐W. D. Tzeng et al.
Notes: Bad sign of advanced disease
Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. BJS 2018; 105: 857-866.
Authors: X.‐F. Zhang, J. Chakedis, F. Bagante, Q. Chen, E. W. Beal, Y. Lv et al.
Notes: Lymphadenectomy is important
Meta‐analysis of an artery‐first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. BJS 2018; 105: 628-636.
Authors: N. Ironside, S. G. Barreto, B. Loveday, S. V. Shrikhande, J. A. Windsor, S. Pandanaboyana et al.
Notes: Benefits to artery‐first approach