• Si Ning Serene Goh, Clement Luck Khng Chia, Jing Wen Ong, John Jian Xian Quek, Woan Wui Lim, Kok Yang Tan, and Jerry Tiong Thye Goo.
• Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore. serene.goh@mohh.com.sg.
• Eur J Trauma Emerg Surg. 2021 Oct 1; 47 (5): 1535-1541.

IntroductionEarly laparoscopic cholecystectomy (ELC) has shown to reduce length of stay and improve patients' satisfaction as compared to delayed laparoscopic cholecystectomy (DLC). However, logistics and manpower limitations often preclude ELC.MethodsA retrospective study was conducted in a single institute to compare outcomes of AC before (August 2013-2014) and after (August 2017-2018) establishment of emergency surgery and trauma (ESAT).ResultsThere were 82 patients in pre-ESAT period and 172 patients in ESAT period. Mean age was 52.3 ± 11.6 and 55.7 ± 13.8 years, respectively, p = 0.369. There were more patients with moderate-severe grading of cholecystitis based on Tokyo Guidelines (TG 18) in ESAT 143/172 (83.1%) as compared to pre-ESAT 65/82 (79.3%), p = 0.042. Index cholecystectomy was performed in 145/172 (84.3%) of patients in the ESAT vs 34/82 (41.5%) of patients in the pre-ESAT period (p = 0.001). Time interval between booking to surgery was 180 ± 56 min in ESAT vs 197 ± 98 min in pre-ESAT, p = 0.014. Operative duration was shorter in ESAT 121 ± 38.5 min vs 139 ± 53.4, in pre-ESAT period, p = 0.030. Conversion rates were lower in ESAT (4/172, 2.3%) vs (9/72, 11%) in pre-ESAT, p = 0.003. Length of stay was shorter in ESAT (DLC 1.89 ± 1.6 and ELC ± 2.9 days) as compared to pre-ESAT (DLC 4.55 ± 2.2 and ELC 5.03 ± 2.6 days), p = 0.001. 30-day readmissions were lower in ESAT (3/172, 1.7%) vs pre-ESAT (8/72, 9.8%).ConclusionThe ESAT model provided more early laparoscopic cholecystectomies with improved efficiency and clinical outcomes.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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