The impact of obesity on outcomes in patients undergoing emergency cholecystectomy for acute cholecystitis.

BACKGROUND: Obesity is a perceived risk factor for poorer surgical outcomes, including increased complication rates and mortality. As obesity rates rise annually, evaluating surgical outcomes in the obese population has become increasingly important. This study examines the impact of obesity on outcomes following emergency laparoscopic cholecystectomy (LC) for acute cholecystitis. METHODS: A retrospective review of patients who underwent emergency LC for acute cholecystitis between March 2018 and March 2021 was performed. A total of 326 patients were included and stratified by body mass index (BMI) into two groups: obese (BMI ≥30 kg/m2 , n = 156) and non-obese (BMI <30 kg/m2 , n = 170). Primary outcomes included length of stay, time to definitive surgery, and postoperative complications. Secondary outcomes included total operative time and intraoperative findings. RESULTS: Obese patients were younger than non-obese patients (median, 45 [34.3-56.8] and 48.5 [34.0-66.3] years; p < 0.001) and had a higher prevalence of diabetes (13.5% versus 6.5%; p = 0.034). Higher American Society of Anesthesiologists (ASA) classification (p < 0.001) and operative grading scores were observed in the obese group (76.3% versus 40.6%, p < 0.001), who were more likely to have a distended gallbladder (19.9% versus 11.2%, p = 0.030) and gallstone impaction (23.1% versus 11.8%, p = 0.007) in comparison to the non-obese group. Length of hospital stay, time to definitive surgery, and postoperative complication rates were similar between groups. CONCLUSION: Although obesity is associated with greater technical difficulty during surgery than non-obese patients, similar postoperative outcomes were achieved. Obesity should not be a contraindication for LC and can be safely performed in the emergency setting.

Comparative Analysis of Models of Care and Its Impact on Emergency Cholecystectomy Outcomes.

Background: The implementation of the acute surgical unit (ASU) model has been demonstrated to improve care outcomes for the emergency general surgery patient in comparison to the traditional "on call" model. Currently, only few studies have evaluated surgical outcomes of the ASU model in patients with acute biliary pathologies. This is the first comparative study of two different emergency surgery structures in the acute management of patients with acute cholecystitis and biliary colic. Methods: A retrospective review of patients who underwent emergency cholecystectomy for acute cholecystitis and biliary colic at two tertiary hospitals between April 2018 and March 2019 was conducted. Primary outcomes included length of hospital stay, time from admission to definitive surgery, and postoperative complications. Secondary outcomes include proportion of cases performed during daylight hours, length of operating time, rate of conversion to open cholecystectomy, and consultant surgeon involvement. Results: A total of 339 patients presented with acute biliary symptoms and were managed operatively. Univariate analysis identified a shorter mean time to surgery in the traditional group compared to the ASU group (29.2 hours versus 43.1 hours; P < .001). There was no difference in mean length of stay, operation duration between models, and postoperative complication rates between groups, with the majority of surgeries performed during daylight hours. The ASU group had a greater proportion of consultant-led cases (48.2% versus 2.5%, P < .001) compared to the traditional group. Conclusion: Patients with acute biliary pathology requiring laparoscopic cholecystectomy achieve equivalent surgical outcomes irrespective of the model of acute surgical care.

An initial psychometric evaluation of the APS-POQ-R in acute pain presenting to the emergency department.

AIM: The purpose of this study was to examine the psychometric properties of a modified version of the American Pain Societies - Patient Outcome Questionnaire - Revised edition in adult patients presenting with acute pain to the emergency department. BACKGROUND: There is a lack of validation and use of patient-reported outcome measures of pain care in the adult emergency setting. DESIGN: Prospective psychometric evaluation. METHODS: Adult patients who had presented with acute pain were invited to participate in the study after their emergency department care. The Questionnaire was administered by one of the investigators. Exploratory factor analysis (principal axis factoring) was used to explore items mapping to constructs. The number of constructs with an Eigenvalue closest to 1 was considered the correct fit for the data. Assessment of the analysis was conducted using the Kaiser-Meier-Olkin test of sampling adequacy, and the fit was assessed using Bartlett's test of sphericity. RESULTS: The Questionnaire demonstrated construct validity in these patients. Exploratory factor analysis demonstrated five constructs. The tool demonstrated discriminatory ability based on patient urgency, and subscale measurement was associated with patient satisfaction with care CONCLUSIONS: The Questionnaire has demonstrable construct validity in adult patients presenting with acute pain to the ED.

Patient-Reported outcomes of pain care research in the adult emergency department: A scoping review.

Despite more than 30 years of research, pain in the emergency department (ED) setting is frequently undertreated. EDs prioritise process measures that often have tenuous links to patient-reported outcomes. However, process measures, such as time to the administration of first analgesic medication, are neither direct objective measures of analgesia nor appropriate surrogate markers of pain relief. Since pain is a subjective symptom that lacks an objective measure, pain research in any clinical environment, including EDs, should rely upon patient-reported outcomes. This scoping review examined patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) of pain care in the adult emergency department at the micro, meso and macro-level over the last ten years. We reviewed pain care research conducted on adults in EDs over the last ten years and identified 57 articles using 14 patient-reported outcomes of pain care falling into five broad areas, most without validation or adaption to the ED setting. Despite efforts made to incorporate PROs and PROMs into acute pain care research in the ED over the last ten years, there is still no gold-standard PROM in widespread use. We recommend the adaptation of existing tools with rigorous validation in ED populations.

Promoting the Learning of Basic Sciences in a Changing Small-Group Learning Landscape. Interviews of tutors and students in a medical program.

This article was migrated. The article was marked as recommended. Tomorrow's medical graduate needs to be equipped today to be able to make sense of continued advancements in medical science and then apply these to the benefit of patents and communities. It is important that current methods of teaching and learning in medical programs such as problem-based learning are subject to critical evaluation as to whether they are fit for purpose, and many medical programs are questioning whether problem-based learning provides adequate grounding in basic science. In this context, we interviewed twelve tutors and four students of one distributed medical program in order to explore their views on what elements of PBL promoted understanding of basic science. Our participants reported that setting a clear agenda about basic science learning was crucial; that tutor preparation and guides needed to take account of different tutor backgrounds; particular styles of prompting and questioning from the tutor were valuable; and that students could benefit from being primed with key introductory concepts about how basic sciences related to each other prior to commencing PBL. These findings will be useful for medical curriculum developers who are seeking to innovate with their curriculum but wish to retain what may be currently most valuable by stakeholders.