Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study
Background Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England. Methods Data from...
Gespeichert in:
| Veröffentlicht in: | Surgical endoscopy 2019-08, Vol.33 (8), p.2495-2502 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2502 |
|---|---|
| container_issue | 8 |
| container_start_page | 2495 |
| container_title | Surgical endoscopy |
| container_volume | 33 |
| creator | Wiggins, Tom Markar, Sheraz R. MacKenzie, Hugh Faiz, Omar Mukherjee, Dipankar Khoo, David E. Purkayastha, Sanjay Beckingham, Ian Hanna, George B. |
| description | Background
Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.
Methods
Data from all consecutive patients undergoing surgery for acute cholecystitis on index admission in England from 1997 to 2012 were captured from the Hospital Episodes Statistics database. Data were analysed based on whether patients underwent surgery 0–3 days, 4–7 days or ≥ 8 days from admission. Outcome measures were rate of post-operative biliary complications, conversion to open and length of stay.
Results
Forty-three thousand eight hundred and seventy patients underwent emergency cholecystectomy. 64.6% of patients underwent surgery between days 0 and 3 of admission, 24.3% between days 4–7 and 11.0% had surgery after day 8. Patients undergoing early surgery had significantly reduced rates of intra-operative laparoscopic conversion to open (0–3 days: 3.6%; 4–7 days: 4.0%; ≥ 8 days 4.7%,
p
= 0.001), post-operative ERCP (0–3 days: 1.1%; 4–7 days: 1.5%; ≥ 8 days 1.9%,
p
|
| doi_str_mv | 10.1007/s00464-018-6537-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6647372</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2202954553</sourcerecordid><originalsourceid>FETCH-LOGICAL-c536t-f8b1a49d9a59c6d5a53888fdbc331897da76e9b6bef5e910ebc7a3680563e3ff3</originalsourceid><addsrcrecordid>eNp1kU9vFSEUxYnR2GfrB3BjSNx0MwrDwIALE9PUP0mTbuyaMMydeTQzMAJjOt--vLzaqokbWJzfPdzDQegNJe8pIe2HREgjmopQWQnO2uruGdrRhtVVXVP5HO2IYqSqW9WcoFcp3ZKCK8pfohNGVKMkpTs0Xy_ZzeuMy-n8iMOAYYY4grcbtvswgd1SBpvDvOEhRGzsmuFJcdkl7Dy-9ONkfP8RL2FZJ5Nd8FVnEvTYhn2IGae89tsZejGYKcHrh_sU3Xy5_HHxrbq6_vr94vNVZTkTuRpkR02jemW4sqLnhjMp5dB3ljEqVdubVoDqRAcDB0UJdLY1TEjCBQM2DOwUfTr6Lms3Q2_B52gmvUQ3m7jpYJz-W_Fur8fwSwvRtKyti8H5g0EMP1dIWc8uWZhKRghr0nVdfl5RJVVB3_2D3oY1-hLvQNWKN5yzQtEjZWNIKcLwuAwl-lCmPpapS5n6UKa-KzNv_0zxOPG7vQLURyAVyY8Qn57-v-s9L8OuZw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2202954553</pqid></control><display><type>article</type><title>Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Wiggins, Tom ; Markar, Sheraz R. ; MacKenzie, Hugh ; Faiz, Omar ; Mukherjee, Dipankar ; Khoo, David E. ; Purkayastha, Sanjay ; Beckingham, Ian ; Hanna, George B.</creator><creatorcontrib>Wiggins, Tom ; Markar, Sheraz R. ; MacKenzie, Hugh ; Faiz, Omar ; Mukherjee, Dipankar ; Khoo, David E. ; Purkayastha, Sanjay ; Beckingham, Ian ; Hanna, George B.</creatorcontrib><description>Background
Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.
Methods
Data from all consecutive patients undergoing surgery for acute cholecystitis on index admission in England from 1997 to 2012 were captured from the Hospital Episodes Statistics database. Data were analysed based on whether patients underwent surgery 0–3 days, 4–7 days or ≥ 8 days from admission. Outcome measures were rate of post-operative biliary complications, conversion to open and length of stay.
Results
Forty-three thousand eight hundred and seventy patients underwent emergency cholecystectomy. 64.6% of patients underwent surgery between days 0 and 3 of admission, 24.3% between days 4–7 and 11.0% had surgery after day 8. Patients undergoing early surgery had significantly reduced rates of intra-operative laparoscopic conversion to open (0–3 days: 3.6%; 4–7 days: 4.0%; ≥ 8 days 4.7%,
p
= 0.001), post-operative ERCP (0–3 days: 1.1%; 4–7 days: 1.5%; ≥ 8 days 1.9%,
p
< 0.001) and bile duct injury (0–3 days: 0.6%; 4–7 days: 1.0%; ≥ 8 days 1.8%,
p
< 0.001). Early cholecystectomy was also associated with a shorter post-operative length of stay (LOS) [0–3 days group: median post-operative LOS 3 days (IQR: 1–6); 4–7 days group: 3 days (IQR 2–6); ≥ 8 days group: 4 days (IQR 2–9) (
p
< 0.001)]. High-volume centres undertook a significantly greater proportion of cholecystectomies within 3 days of presentation (high-volume: 67.3%; medium-volume: 64.8%; low-volume: 61.2%). In multivariate analysis greater time to surgery was independently associated with increased risk of post-operative ERCP and bile duct injury.
Conclusions
Early cholecystectomy within 3 days of admission reduces intra-operative conversion, post-operative biliary complications and length of stay. Centres undertaking the greatest numbers of emergency cholecystectomies perform a larger proportion within 3 days of admission.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-018-6537-x</identifier><identifier>PMID: 30949811</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Bile ; Cholecystectomy ; Cholecystectomy, Laparoscopic - standards ; Cholecystitis, Acute - surgery ; Cohort analysis ; Cohort Studies ; Emergencies ; Emergency Service, Hospital ; England - epidemiology ; Female ; Gallbladder diseases ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity - trends ; Population Surveillance ; Population-based studies ; Proctology ; Surgery</subject><ispartof>Surgical endoscopy, 2019-08, Vol.33 (8), p.2495-2502</ispartof><rights>The Author(s) 2019</rights><rights>Surgical Endoscopy is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-f8b1a49d9a59c6d5a53888fdbc331897da76e9b6bef5e910ebc7a3680563e3ff3</citedby><cites>FETCH-LOGICAL-c536t-f8b1a49d9a59c6d5a53888fdbc331897da76e9b6bef5e910ebc7a3680563e3ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-018-6537-x$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-018-6537-x$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30949811$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wiggins, Tom</creatorcontrib><creatorcontrib>Markar, Sheraz R.</creatorcontrib><creatorcontrib>MacKenzie, Hugh</creatorcontrib><creatorcontrib>Faiz, Omar</creatorcontrib><creatorcontrib>Mukherjee, Dipankar</creatorcontrib><creatorcontrib>Khoo, David E.</creatorcontrib><creatorcontrib>Purkayastha, Sanjay</creatorcontrib><creatorcontrib>Beckingham, Ian</creatorcontrib><creatorcontrib>Hanna, George B.</creatorcontrib><title>Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.
Methods
Data from all consecutive patients undergoing surgery for acute cholecystitis on index admission in England from 1997 to 2012 were captured from the Hospital Episodes Statistics database. Data were analysed based on whether patients underwent surgery 0–3 days, 4–7 days or ≥ 8 days from admission. Outcome measures were rate of post-operative biliary complications, conversion to open and length of stay.
Results
Forty-three thousand eight hundred and seventy patients underwent emergency cholecystectomy. 64.6% of patients underwent surgery between days 0 and 3 of admission, 24.3% between days 4–7 and 11.0% had surgery after day 8. Patients undergoing early surgery had significantly reduced rates of intra-operative laparoscopic conversion to open (0–3 days: 3.6%; 4–7 days: 4.0%; ≥ 8 days 4.7%,
p
= 0.001), post-operative ERCP (0–3 days: 1.1%; 4–7 days: 1.5%; ≥ 8 days 1.9%,
p
< 0.001) and bile duct injury (0–3 days: 0.6%; 4–7 days: 1.0%; ≥ 8 days 1.8%,
p
< 0.001). Early cholecystectomy was also associated with a shorter post-operative length of stay (LOS) [0–3 days group: median post-operative LOS 3 days (IQR: 1–6); 4–7 days group: 3 days (IQR 2–6); ≥ 8 days group: 4 days (IQR 2–9) (
p
< 0.001)]. High-volume centres undertook a significantly greater proportion of cholecystectomies within 3 days of presentation (high-volume: 67.3%; medium-volume: 64.8%; low-volume: 61.2%). In multivariate analysis greater time to surgery was independently associated with increased risk of post-operative ERCP and bile duct injury.
Conclusions
Early cholecystectomy within 3 days of admission reduces intra-operative conversion, post-operative biliary complications and length of stay. Centres undertaking the greatest numbers of emergency cholecystectomies perform a larger proportion within 3 days of admission.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Bile</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy, Laparoscopic - standards</subject><subject>Cholecystitis, Acute - surgery</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Emergencies</subject><subject>Emergency Service, Hospital</subject><subject>England - epidemiology</subject><subject>Female</subject><subject>Gallbladder diseases</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity - trends</subject><subject>Population Surveillance</subject><subject>Population-based studies</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU9vFSEUxYnR2GfrB3BjSNx0MwrDwIALE9PUP0mTbuyaMMydeTQzMAJjOt--vLzaqokbWJzfPdzDQegNJe8pIe2HREgjmopQWQnO2uruGdrRhtVVXVP5HO2IYqSqW9WcoFcp3ZKCK8pfohNGVKMkpTs0Xy_ZzeuMy-n8iMOAYYY4grcbtvswgd1SBpvDvOEhRGzsmuFJcdkl7Dy-9ONkfP8RL2FZJ5Nd8FVnEvTYhn2IGae89tsZejGYKcHrh_sU3Xy5_HHxrbq6_vr94vNVZTkTuRpkR02jemW4sqLnhjMp5dB3ljEqVdubVoDqRAcDB0UJdLY1TEjCBQM2DOwUfTr6Lms3Q2_B52gmvUQ3m7jpYJz-W_Fur8fwSwvRtKyti8H5g0EMP1dIWc8uWZhKRghr0nVdfl5RJVVB3_2D3oY1-hLvQNWKN5yzQtEjZWNIKcLwuAwl-lCmPpapS5n6UKa-KzNv_0zxOPG7vQLURyAVyY8Qn57-v-s9L8OuZw</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Wiggins, Tom</creator><creator>Markar, Sheraz R.</creator><creator>MacKenzie, Hugh</creator><creator>Faiz, Omar</creator><creator>Mukherjee, Dipankar</creator><creator>Khoo, David E.</creator><creator>Purkayastha, Sanjay</creator><creator>Beckingham, Ian</creator><creator>Hanna, George B.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190801</creationdate><title>Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study</title><author>Wiggins, Tom ; Markar, Sheraz R. ; MacKenzie, Hugh ; Faiz, Omar ; Mukherjee, Dipankar ; Khoo, David E. ; Purkayastha, Sanjay ; Beckingham, Ian ; Hanna, George B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c536t-f8b1a49d9a59c6d5a53888fdbc331897da76e9b6bef5e910ebc7a3680563e3ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Bile</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy, Laparoscopic - standards</topic><topic>Cholecystitis, Acute - surgery</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Emergencies</topic><topic>Emergency Service, Hospital</topic><topic>England - epidemiology</topic><topic>Female</topic><topic>Gallbladder diseases</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity - trends</topic><topic>Population Surveillance</topic><topic>Population-based studies</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wiggins, Tom</creatorcontrib><creatorcontrib>Markar, Sheraz R.</creatorcontrib><creatorcontrib>MacKenzie, Hugh</creatorcontrib><creatorcontrib>Faiz, Omar</creatorcontrib><creatorcontrib>Mukherjee, Dipankar</creatorcontrib><creatorcontrib>Khoo, David E.</creatorcontrib><creatorcontrib>Purkayastha, Sanjay</creatorcontrib><creatorcontrib>Beckingham, Ian</creatorcontrib><creatorcontrib>Hanna, George B.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wiggins, Tom</au><au>Markar, Sheraz R.</au><au>MacKenzie, Hugh</au><au>Faiz, Omar</au><au>Mukherjee, Dipankar</au><au>Khoo, David E.</au><au>Purkayastha, Sanjay</au><au>Beckingham, Ian</au><au>Hanna, George B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>33</volume><issue>8</issue><spage>2495</spage><epage>2502</epage><pages>2495-2502</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.
Methods
Data from all consecutive patients undergoing surgery for acute cholecystitis on index admission in England from 1997 to 2012 were captured from the Hospital Episodes Statistics database. Data were analysed based on whether patients underwent surgery 0–3 days, 4–7 days or ≥ 8 days from admission. Outcome measures were rate of post-operative biliary complications, conversion to open and length of stay.
Results
Forty-three thousand eight hundred and seventy patients underwent emergency cholecystectomy. 64.6% of patients underwent surgery between days 0 and 3 of admission, 24.3% between days 4–7 and 11.0% had surgery after day 8. Patients undergoing early surgery had significantly reduced rates of intra-operative laparoscopic conversion to open (0–3 days: 3.6%; 4–7 days: 4.0%; ≥ 8 days 4.7%,
p
= 0.001), post-operative ERCP (0–3 days: 1.1%; 4–7 days: 1.5%; ≥ 8 days 1.9%,
p
< 0.001) and bile duct injury (0–3 days: 0.6%; 4–7 days: 1.0%; ≥ 8 days 1.8%,
p
< 0.001). Early cholecystectomy was also associated with a shorter post-operative length of stay (LOS) [0–3 days group: median post-operative LOS 3 days (IQR: 1–6); 4–7 days group: 3 days (IQR 2–6); ≥ 8 days group: 4 days (IQR 2–9) (
p
< 0.001)]. High-volume centres undertook a significantly greater proportion of cholecystectomies within 3 days of presentation (high-volume: 67.3%; medium-volume: 64.8%; low-volume: 61.2%). In multivariate analysis greater time to surgery was independently associated with increased risk of post-operative ERCP and bile duct injury.
Conclusions
Early cholecystectomy within 3 days of admission reduces intra-operative conversion, post-operative biliary complications and length of stay. Centres undertaking the greatest numbers of emergency cholecystectomies perform a larger proportion within 3 days of admission.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30949811</pmid><doi>10.1007/s00464-018-6537-x</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2019-08, Vol.33 (8), p.2495-2502 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6647372 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Adult Aged Bile Cholecystectomy Cholecystectomy, Laparoscopic - standards Cholecystitis, Acute - surgery Cohort analysis Cohort Studies Emergencies Emergency Service, Hospital England - epidemiology Female Gallbladder diseases Gastroenterology Gynecology Hepatology Humans Length of Stay Male Medicine Medicine & Public Health Middle Aged Morbidity - trends Population Surveillance Population-based studies Proctology Surgery |
| title | Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T13%3A41%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Optimum%20timing%20of%20emergency%20cholecystectomy%20for%20acute%20cholecystitis%20in%20England:%20population-based%20cohort%20study&rft.jtitle=Surgical%20endoscopy&rft.au=Wiggins,%20Tom&rft.date=2019-08-01&rft.volume=33&rft.issue=8&rft.spage=2495&rft.epage=2502&rft.pages=2495-2502&rft.issn=0930-2794&rft.eissn=1432-2218&rft_id=info:doi/10.1007/s00464-018-6537-x&rft_dat=%3Cproquest_pubme%3E2202954553%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2202954553&rft_id=info:pmid/30949811&rfr_iscdi=true |