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Significant variation in early gallbladder surgery across Ontario’s hospitals


The timing of surgery for acute gallbladder inflammation varies widely across hospitals in Ontario, according to a new study published in CMAJ Open today by researchers from Sunnybrook Health Sciences Centre, the Institute for Clinical Evaluative Sciences (ICES) and St. Michael’s Hospital.

“We found that similar patients with gallbladder inflammation were managed very differently depending on the hospital to which they presented,” says Dr. Charles de Mestral, the study’s first author and general surgery resident at Sunnybrook.

Patients with acute gallbladder inflammation, known as acute cholecystitis, can be managed with early surgical removal of the gallbladder within a few days of presenting to an emergency room. The initial attack of acute inflammation can also be managed non-operatively, with surgery delayed from two to three months until the inflammation settles.

Despite evidence in favour of early surgery for most patients with gallbladder inflammation, delayed surgery remains a common management strategy at hospitals worldwide, even though it can be harder on the patient.

“While both approaches are considered to be safe, it is far simpler for the patient to have early surgery. After early gallbladder removal, the patient is generally back to work within a few weeks. Delaying surgery means a longer total hospital stay and more time off work,” says primary investigator Dr. Avery Nathens, surgeon-in-chief at Sunnybrook and professor, department of surgery at the University of Toronto.

Additionally, one in five patients will have painful recurrent gallbladder symptoms while they wait to have their gallbladder removed.

The study included 24,437 Ontarians with a first episode of acute gallbladder inflammation between 2004 and 2010. In some hospitals, fewer than 25% of patients had early surgery, whereas at other hospitals this number increased to over 75%.

Dr. de Mestral and his colleagues attribute some of the difference in early gallbladder removal rates to hospital-level factors, including availability of operating rooms and other clinical priorities of the hospital’s medical staff.

“We still need to look further into why rates of early surgery differ so much. Is it surgeon beliefs, or is it a lack of resources or training? We’re in the process of surveying surgeons in Ontario to better understand the barriers they may be facing in offering early surgery,” says Dr. de Mestral. “Despite any barriers, acute cholecystitis is a very common disease, so all hospitals need to develop local solutions to efficiently treat these patients.”

The study was funded by operating grants from the Canadian Surgical Research Fund, Physician Services Inc. Foundation and ICES.



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