Abstract：
The perioperative management of biliary disease (BD) is variable across institutions with suboptimal outcomes for patients and health care systems. This results in inefficient utilization of limited resources. The aim of the current study was to identify modifiable factors impacting patients\' time to theater, intraoperative time, and time to discharge as the constituents of length of stay to guide creation of a perioperative management protocol to address this variability.
Data were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge.
Four thousand five hundred seventy-seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement.
Standardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.
Data were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge.
Four thousand five hundred seventy-seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement.
Standardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.
摘要：
背景：胆道疾病（BD）的围手术期管理在不同机构中存在差异，患者和医疗保健系统的结局不佳。这导致有限资源的低效利用。本研究的目的是确定影响患者去剧院时间的可改变因素，术中时间,和出院时间作为住院时间的组成部分，以指导制定围手术期管理方案来解决这种变异性。
方法：在2015年5月至2022年5月期间，在基督城医院收集了所有接受胆囊切除术的成年患者的前瞻性数据。Pre,post,评估术中因素对到达剧院时间的影响，手术时间,以及术后出院时间。
结果：在研究期间，四千五百77例患者接受了胆囊切除术，其中2807例(61%)为急性表现，并组成队列进行分析。到达剧院的时间受到术前影像学类型的显着影响，而手术级别和手术类型对手术时间的临床意义最大。术后出院时间受到引流管放置的显着影响。
结论：BD的标准化管理可能会为医疗保健系统节省大量资金，并改善患者的预后。这里看到的数据证明了适当成像选择的重要性，术中难度手术等级识别，和低吸力排水选择。这些数据已被纳入围手术期管理协议，因为BD患者工作流程中的护理标准化是确保稀缺资源最佳使用的明智方法。
方法：在2015年5月至2022年5月期间，在基督城医院收集了所有接受胆囊切除术的成年患者的前瞻性数据。Pre,post,评估术中因素对到达剧院时间的影响，手术时间,以及术后出院时间。
结果：在研究期间，四千五百77例患者接受了胆囊切除术，其中2807例(61%)为急性表现，并组成队列进行分析。到达剧院的时间受到术前影像学类型的显着影响，而手术级别和手术类型对手术时间的临床意义最大。术后出院时间受到引流管放置的显着影响。
结论：BD的标准化管理可能会为医疗保健系统节省大量资金，并改善患者的预后。这里看到的数据证明了适当成像选择的重要性，术中难度手术等级识别，和低吸力排水选择。这些数据已被纳入围手术期管理协议，因为BD患者工作流程中的护理标准化是确保稀缺资源最佳使用的明智方法。
