{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:02:51Z","timestamp":1767139371117,"version":"build-2238731810"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T00:00:00Z","timestamp":1564963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T00:00:00Z","timestamp":1564963200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T00:00:00Z","timestamp":1564963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The Tokyo Guidelines 2018 (TG18) were developed to aid diagnosis and treatment for acute cholecystitis. The benefits of being treated in an acute general surgical unit (AGSU) include earlier diagnosis and treatment. This study aims to define the usefulness of TG18 before and after the introduction of AGSU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>Patients who underwent cholecystectomy at Northern Health were audited retrospectively and assessed for TG18 diagnostic criteria and outcomes between 1 February 2012 and 1 February 2014 (one\u2010year pre\u2010 and post\u2010AGSU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five hundred and eighty\u2010seven patients underwent emergency cholecystectomy with 203 (34.6%) patients having a suspected diagnosis, and 234 (39.9%) patients with a definitive diagnosis of acute cholecystitis using TG18 diagnostic criteria. After the introduction of AGSU, time from imaging to operation improved from 2.5 to 1.7\u00a0days (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). There were more operations occurring during in\u2010hours following AGSU implementation (75.8% vs. 62.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Maximum pre\u2010operative CRP of\u2009&gt;26.6\u00a0mg\/L had a higher likelihood of Clavien\u2013Dindo complication grade 3 or 4 (OR 3.86, 95%CI 1.18\u201312.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027) compared with TG18 definitive diagnosis criteria (OR 1.50, 95%CI 0.46\u20134.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.501). Surprisingly, there was a trend towards higher complications and readmissions for patients operated within 24 h, although this trend was not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with suspected acute cholecystitis should be stratified clinically and with CRP in an AGSU with TG18 adding little value in a busy metropolitan unit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-019-05104-w","type":"journal-article","created":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T14:03:37Z","timestamp":1565013817000},"page":"2762-2769","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["An Acute General Surgical Unit (AGSU) Negates the Impact of the Tokyo Guidelines 2018 (TG18) Diagnostic Criteria for the Treatment of Acute Cholecystitis"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9269-9001","authenticated-orcid":false,"given":"Yuchen","family":"Luo","sequence":"first","affiliation":[{"name":"Northern Health 185 Cooper Street 3076 Epping VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marang","family":"Makepe","sequence":"additional","affiliation":[{"name":"Northern Health 185 Cooper Street 3076 Epping VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Yim","sequence":"additional","affiliation":[{"name":"Northern Health 185 Cooper Street 3076 Epping VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Tacey","sequence":"additional","affiliation":[{"name":"Northern Health 185 Cooper Street 3076 Epping VIC Australia"},{"name":"Department of Medicine, Dentistry and Health Sciences University of Melbourne 3052 Parkville VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bird","sequence":"additional","affiliation":[{"name":"Northern Health 185 Cooper Street 3076 Epping VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell","family":"Hodgson","sequence":"additional","affiliation":[{"name":"Northern Health 185 Cooper Street 3076 Epping VIC Australia"},{"name":"University of Melbourne 185 Cooper Street 3076 Epping VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,5]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"ZakkoS ChopraS GroverS(2018)Overview of gallstone disease in adults. 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