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The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and \u2018real-world\u2019 contemporary practice across Europe.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45\u00b70 per cent) underwent index admission cholecystectomy, 17 (5\u00b70 per cent) had interval cholecystectomy, and the remaining 169 (50\u00b70 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery \u2018on call\u2019 service (57 versus 38 per cent respectively; odds ratio 2\u00b714 (95 per cent c.i. 1\u00b737 to 3\u00b735), P &amp;lt; 0\u00b7001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30\u00b75 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93\u00b75 per cent) of patients in the snapshot audit received antibiotics during their index admission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs5.50294","type":"journal-article","created":{"date-parts":[[2020,5,17]],"date-time":"2020-05-17T17:38:31Z","timestamp":1589737111000},"page":"622-629","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated 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