{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:13:01Z","timestamp":1761894781920},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2008,10,15]],"date-time":"2008-10-15T00:00:00Z","timestamp":1224028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2008,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Acute gallstone disease is a common indication for emergency hospital admission, and evidence now strongly supports early laparoscopic cholecystectomy as the treatment of choice. Recent data from the UK suggest that this is achieved in a minority of cases with a high proportion of patients managed by deferred elective surgery or emergency open cholecystectomy. We present results of a policy of definitive treatment during index admission after subspecialist reorganization of a regional emergency surgical service.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data for all emergency gallstone admissions were retrieved from a prospectively collected regional surgical audit database and results were compared from 31\u00a0month periods before and after subspecialist service reorganization in August 2002.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2442 patients were analyzed. Before subspecialization, 458 of 733 patients (62.4%) underwent cholecystectomy during index admission; after subspecialization, cholecystectomy during index admission for biliary colic\/acute cholecystitis was achieved in 666 of 817 (81.5%) patients (90.2% laparoscopic, 6.5% conversion rate, and 3.3% primary open cholecystectomy) with a reduction in hospital stay from median 5 to 4\u00a0days. The rate of deferred surgery decreased from 37.5% to 18.4%. Early surgery reduced total hospital admission by more than 1\u00a0day per patient compared with deferred surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early laparoscopic cholecystectomy during emergency admission is cost\u2010effective and should be regarded as the standard of care. However, it requires appropriately trained surgeons and availability of a dedicated emergency room, which at present are not consistently provided in all regions of the UK.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-008-9749-8","type":"journal-article","created":{"date-parts":[[2008,10,14]],"date-time":"2008-10-14T16:08:34Z","timestamp":1224000514000},"page":"2690-2694","source":"Crossref","is-referenced-by-count":19,"title":["Improved Management of Acute Gallstone Disease After Regional Surgical Subspecialization"],"prefix":"10.1002","volume":"32","author":[{"given":"D. J.","family":"Simpson","sequence":"first","affiliation":[{"name":"Clinical and Surgical Sciences (Surgery) Royal Infirmary of Edinburgh Little France Crescent EH16 4SA Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. M.","family":"Wood","sequence":"additional","affiliation":[{"name":"Clinical and Surgical Sciences (Surgery) Royal Infirmary of Edinburgh Little France Crescent EH16 4SA Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. M.","family":"Paterson","sequence":"additional","affiliation":[{"name":"Department of Coloproctology Western General Hospital Crewe Road South EH4 2XU Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. J.","family":"Nixon","sequence":"additional","affiliation":[{"name":"Clinical and Surgical Sciences (Surgery) Royal Infirmary of Edinburgh Little France Crescent EH16 4SA Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Paterson\u2010Brown","sequence":"additional","affiliation":[{"name":"Clinical and Surgical Sciences (Surgery) Royal Infirmary of Edinburgh Little France Crescent EH16 4SA Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2008,10,15]]},"reference":[{"key":"e_1_2_7_2_2","volume-title":"Delivering quality and value: focus on cholecystectomy","author":"NHS Institute for Innovation and Improvement","year":"2006"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800681102"},{"key":"e_1_2_7_4_2","first-page":"20","article-title":"Consequences of prolonged wait before gallbladder surgery","volume":"84","author":"Cheruvu CV","year":"2002","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.78.925.668"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4836"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199804000\u201000001"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(97)08447\u2010X"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010001\u20100122\u20104"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800811130"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102168.1998.00708.x"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313480006600921"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010005\u20100100\u20102"},{"key":"e_1_2_7_14_2","first-page":"CD005440","article-title":"Early versus delayed laparoscopic cholecystectomy for acute cholecystitis","volume":"4","author":"Gurusamy KS","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5984"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602894"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2004.03.010"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1308\/003588406X94913"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4458"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1308\/003588403769162404"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/003693300104600207"},{"issue":"1","key":"e_1_2_7_22_2","first-page":"67","article-title":"Separation of upper and lower gastrointestinal surgery","volume":"91","author":"Elson D","year":"2004","journal-title":"Br J Surg"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4831"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000252402.33814.dd"},{"key":"e_1_2_7_25_2","unstructured":"Association of Surgeons of Great Britain and Ireland(2007) Emergency general surgery: the future.A consensus statement"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-008-9749-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-008-9749-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-008-9749-8","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T15:05:12Z","timestamp":1703603112000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-008-9749-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,10,15]]},"references-count":24,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2008,12]]}},"alternative-id":["10.1007\/s00268-008-9749-8"],"URL":"https:\/\/doi.org\/10.1007\/s00268-008-9749-8","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,10,15]]}}}