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Ravi Vohra West Midlands Research Collaborative

Clinical Variation in Practice of Laparoscopic Chole cystectomy and S urgical Outcomes: a multi-centre, prospective, population-based cohort study. Ravi Vohra West Midlands Research Collaborative . Why?. Management varies widely between surgeons and hospitals Acute vs. Elective

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Ravi Vohra West Midlands Research Collaborative

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  1. Clinical Variation in Practice of Laparoscopic Cholecystectomy and Surgical Outcomes: amulti-centre, prospective, population-based cohort study Ravi Vohra West Midlands Research Collaborative

  2. Why? • Management varies widely between surgeons and hospitals • Acute vs. Elective • Cholecystectomyis common • 66,000 cholecystectomies were performed during the 2011-12 financial year in England alone • Trainees are involved in

  3. Evidence? • Level 1 evidence support early or acute laparoscopic cholecytectomyin: • Biliary colic (1 RCT, n=75) • Cholecystitis (6 RCTs, n=488) • Gallstone pancreatitis (1RCT, n=303) (Meta-analysis)

  4. Retrospective data Harrison et al. BMJ, 2012;344:e3330 Sinha et al. SurgEndosc, 2013;27(1):162-75.

  5. Nottingham CCG AUGIS/RCS 2013

  6. Aim • Hypothesis: Within the UK different practices are being adopted resulting in important differences in surgical outcomes • To investigate surgical outcomes following acute, ‘delayed’ and elective cholecystectomies • Multi-centre, contemporary, prospective, cohort study • Audit standard: All-cause 30-day readmission rate should be less than 10% following cholecystectomy (primary outcome measure)

  7. Methods • Two-month period (March- April 2014) with 30 day follow up • All patients undergoing cholecystectomy • Acute (first acute admission with biliary disease through A&E or GP and cholecystectomy performed during that index admission) • Elective (planned elective admission for cholecystectomy who have been referred from their GP and added to the routine surgical waiting list from the outpatient department only • Delayed (all other planned cholecystectomies).

  8. 28 Data points Post-operative data In-hospital complications In-hospital re-interventions and re-imaging Date of discharge 30-day data All-cause A&E attendance All-cause 30-day readmission Date of re-admission Complications Re-interventions and re-imaging Date of discharge following readmission 30-day mortality Preoperative • Age; Gender, BMI, ASA • Current Admission Date • Operation Date • Timing of Surgery • Pre-operative indication • Number of previous surgical admissions • Investigations Intra-operative data • Seniority of surgeons • Speciality of surgeon • Perioperative antibiotics • Method of operation • Degree of difficulty • Complications • Intraoperativecholangiography • CBD exploration performed • Abdominal drain left at the end

  9. Pilot One week, 5 centres • 34 Choles • All laparoscopic • Range 0 - 15 procedures • LoHS 1 day (0-5 days)

  10. Conclusion Population-based cohort study Determine variation and impact on surgical outcomes in a non-trial cohort ‘The Power of Many’ West Midlands ~1500 England ~ 10,000 UK ~ 12,000 Ewen.griffiths@uhb.nhs.uk Ravinder.vohra@uhb.nhs.uk www.choles-study.org

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