2024 General Surgery/Global Health Engagement/Quality Improvement Presentations

Margaret Shields1; Marcus Kunzmanm1; Keith Sellers, MD2; Rathnayaka Gunasingha, MD2; Carolyn Gosztyla, MD2; Ashley Humphries, MD2; Elliott Jessie, MD2; Carlos Rodriguez, MD3; Judy Logeman, DNP, RN2; Patrick Walker, MD2; Matthew Bradley, MD2; 1Uniformed Services University of the Health Sciences; 2Walter Reed National Military Medical Center; 3Texas Health Harris Methodist Hospital

Introduction: One of the roles of an emergency general surgery (EGS) registry is to standardize treatment algorithms for various emergent, non-trauma surgeries by creating multi-disciplinary protocols. We reviewed the treatment trends and outcomes for the most common EGS referrals in our registry.

Methods: This study is a retrospective review of the quality of care provided to patients with acute cholecystitis. The data accumulated in a multidisciplinary EGS registry at a tertiary military hospital over a five-year period was reviewed to identify trends in acute cholecystitis management as part of a process improvement initiative.

Results: Of the 274 cholecystectomies from 2017 to 2022, 253 (92.3%) were laparoscopic total cholecystectomies. There were 9 patients (3.2%) who underwent laparoscopic to open total cholecystectomies. Eleven  patients (4.0%) underwent subtotal cholecystectomies. Of these, 6 were laparoscopic to open fenestrating procedures, and 5 were laparoscopic fenestrating procedures. Postoperative ERCP was required in 33% of the laparoscopic to open subtotal procedures and 40% of the laparoscopic procedures for bile leak. Median length of stay was 7.5 days (IQR 3-15) for laparoscopic to open subtotal procedures and 4 days (IQR 4-5) for subtotal procedures that remained laparoscopic. There were no common bile or hepatic duct injuries regardless of procedure.

Conclusion: The experience in this registry demonstrates that most patients who undergo subtotal cholecystectomy do not require postoperative ERCP for bile leak. The trend towards decreased length of stay in subtotal cholecystectomies that remain laparoscopic has changed our pattern of practice. These findings demonstrate the value in EGS registry review in improving outcomes for patients.