Initial outcomes of a surgical ambulatory pathway for right upper quadrant pain

Yat Cheung Chung; Raelene Tan; Coates Thomas; Suellyn Centauri; Andrew Gray; Sarah A. Martin

doi:10.18203/2349-2902.isj20263339

Authors

Yat Cheung Chung Department of Surgery, Monash Health, Clayton, Victoria, Australia
Raelene Tan Department of Surgery, Monash Health, Clayton, Victoria, Australia
Coates Thomas Department of Surgery, Monash Health, Clayton, Victoria, Australia
Suellyn Centauri Department of Surgery, Monash Health, Clayton, Victoria, Australia
Andrew Gray Department of Surgery, Monash Health, Clayton, Victoria, Australia; Monash University, Victoria, Australia
Sarah A. Martin Department of Surgery, Monash Health, Clayton, Victoria, Australia; Monash University, Victoria, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20263339

Keywords:

Right upper quadrant pain, Ambulatory Care Pathway, Inpatient care pathway, Emergency surgery, General surgery

Abstract

Background: Right upper quadrant (RUQ) abdominal pain is a common emergency presentation. Ambulatory care pathways (ACP) are described as management strategies to reduce hospital bed pressure. ACP allows well patients presenting out of hours to be discharged from the emergency department, with a plan for re-presentation for further management. The aim of this study is to demonstrate that select patients with RUQ pain can be managed via ACP to achieve shorter inpatient length of stay (LOS) without higher morbidity or mortality.

Methods: Prospective data on eligible patients treated via ACP for RUQ pain between June 2021 and 2022 were compared with a retrospectively collected matched cohort of inpatient care pathway (ICP) patients from June 2019 to June 2020. Data collected included patient demographics, diagnosis, LOS, complications, and readmissions within 30 days.

Results: Patients on the ACP had significantly shorter LOS (p<0.001) with a median LOS of 1.0 (IQR 0.0-1.30) compared to patients on the ICP with a median of 2.0 (IQR 1.25-2.75). There were no significant differences in patient demographics, theatre access, surgical complications, or readmissions within 30 days.

Conclusions: Patients who presented out of hours with RUQ pain treated through the ACP had a shorter LOS without increased morbidity or mortality. ACP management of RUQ pain appears safe for patients who meet strict criteria.

Metrics

Metrics Loading ...

References

Mollah T, Christie H, Chia M, Modak P, Joshi K, Soni T, et al. Gallbladder-associated hospital admission and cholecystectomy rates across Australia and Aotearoa New Zealand (2004-2019): Are we over-intervening? Ann Hepatobiliary Pancreat Surg. 2022;26(4):339-46. DOI: https://doi.org/10.14701/ahbps.22-007

Vanhaecht K, Panella M, van Zelm R, Sermeus W. An overview on the history and concept of care pathways as complex interventions. Int J Care Pathw. 2010;14(3):117-23. DOI: https://doi.org/10.1258/jicp.2010.010019

Vanhaecht K, Ovretveit J, Elliott MJ, Sermeus W, Ellershaw J, Panella M. Have We Drawn the Wrong Conclusions About the Value of Care Pathways? Is a Cochrane Review Appropriate? Eval Health Prof. 2012;35(1):28-42. DOI: https://doi.org/10.1177/0163278711408293

Trejo-Ávila ME, Romero-Loera S, Cárdenas-Lailson E, Blas-Franco M, Delano-Alonso R, Valenzuela-Salazar C, et al. Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial. Surg Endosc. 2019;33(2):429-36. DOI: https://doi.org/10.1007/s00464-018-6315-9

Bailey CR, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A, et al. Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia. 2019;74(6):778-92. DOI: https://doi.org/10.1111/anae.14639

Kazem MA, Hopley C, Corless DJ. Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service. Ann Med Surg (Lond). 2019;43:17-24. DOI: https://doi.org/10.1016/j.amsu.2019.05.004

Gaszynski R, Gray A, Chan DL, Merrett N. Fast-track ambulatory abscess pathway: an Australian streamlined emergency surgery pathway. ANZ J Surg. 2020;90(3):268-71. DOI: https://doi.org/10.1111/ans.15494

Fazzalari A, Srinivas S, Panjwani S, Pozzi N, Friedrich A, Sheoran R, et al. A Fast-Track Pathway for Emergency General Surgery at an Academic Medical Center. J Surgical Res. 2021;267:1-8. DOI: https://doi.org/10.1016/j.jss.2021.04.012

Zhang M, Zhou SY, Xing MY, Xu J, Shi XX, Zheng SS. The application of clinical pathways in laparoscopic cholecystectomy. Hepatobiliary Pancreatic Dis Int. 2014;13(4):348-53. DOI: https://doi.org/10.1016/S1499-3872(14)60279-4

Ryan R, Davoren J, Grant H, Delbridge L. A 23‐hour care centre model for the management of surgical patients. ANZ J Surg. 2004;74(9):754-9. DOI: https://doi.org/10.1111/j.1445-1433.2004.03140.x

Schofield DJ, Earnest A. Demographic change and the future demand for public hospital care in Australia, 2005 to 2050. Australian Health Rev. 2006;30(4):507. DOI: https://doi.org/10.1071/AH060507

Coates T, Tan RYM, Chung YC, Gray A, Centauri S, Martin S. Safety and efficacy of a surgical ambulatory care pathway for superficial abscesses. ANZ J Surg. 2025;96(3):651-6. DOI: https://doi.org/10.1111/ans.70050

Arabacioglu D, Lehn A, Herrmann E, Albers B, Hanisch E, Buia A. Evaluating a Clinical Pathway in Laparoscopic Cholecystectomy: Effective in Reducing Complications? A Propensity Score Matching Analysis. Visc Med. 2021;37(1):70-6. DOI: https://doi.org/10.1159/000506718

Hauck K, Zhao X. How Dangerous is a Day in Hospital? Med Care. 2011;49(12):1068-75. DOI: https://doi.org/10.1097/MLR.0b013e31822efb09