CholeS

Clinical Variation in Practice of Laparoscopic Cholecystectomy and Surgical Outcomes: a multi-centre, prospective, population-based cohort study (CholeS Study: A West Midlands Research Collaborative Study)

Background: Cholecystectomy is one of the most common general surgical operations performed in the UK. Increasing proportions of patients have surgery in the acute setting for severe biliary colic, cholecystitis and following gallstone pancreatitis (Learn about the gallbladder). Randomised clinical trials in acute cholecystitis and gallstone pancreatitis suggest early laparoscopic surgery performed in specialist units is safe. Despite this, management still differs between surgeons and centres across the UK. This has been highlighted in a recent commissioning guide produced jointly by the Royal College of Surgeons and the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The impact of these variations on outcomes is unclear.

Aim: To investigate surgical outcomes following acute, ‘delayed’ and elective cholecystectomies in a population-based cohort (Find out more about gallbladder surgery)

 Audit standard: All-cause 30-day readmission rate should be less than 10% following cholecystectomy (primary outcome measure). Secondary outcome measures are all highlighted variable within the commissioning guide: pre-operative (demographics, admission type, diagnostic tests) peri-operative (difficulty of the operation (learn how to grade the difficulty), bile duct injury (learn more)) and post-operative (length of stay, in-hospital morbidity (Find out how to classify complications)) factors.   

 Methods: The study will be performed over a two-month period from March 2014. Participation from centres in the UK is estimated to recruit 10,000 patients. The study will be performed using a standardised database at each centre. Inclusion criteria will be: All patients undergoing cholecystectomy will be categorised into one of three groups: (1) Acute Cholecystectomy (first acute admission with biliary disease through A&E or GP and cholecystectomy performed during that index admission); (2) Elective Cholecystectomy (planned elective admission for cholecystectomy who have been referred from their GP and added to the routine surgical waiting list from the outpatient department only and (3) Delayed Cholecystectomy (all other planned cholecystectomies). Variation in practice will be assessed by all-cause 30-day readmission rates, by centre. In addition, the influence of pre-operative factors and effects on peri- and post-operative measures will be investigated.

  Discussion: This multi-centre, prospective, population-based study will be delivered by a trainee-led collaborative research networks to ensure high volume without compromising quality.

For more information, please see the links below:

CholeS talk – Powerpoint 
AUDIT APROVAL EMAIL 21st August 2013 (1)
**NEW** List of authors
**NEW** CholeS contribution letter
CholeS Protocol Final v1.17

11 thoughts on “CholeS

  1. Dear CholeS Collaborator and interested parties,

    CholeS Study: Published Papers

    The main papers from the CholeS study have now been published and are on PubMed and the Journals website:

    1. Population based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/bjs.10287

    2. Population based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/bjs.10288

    3. Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology

    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/bjs.10317

    4. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. (AVAILABLE FREE ONLINE)

    https://www.ncbi.nlm.nih.gov/pubmed/27591176

    There has been a significant amount of interest in our work on social media and that has helped boost our Altmetric Score’s; making the CholeS papers become within the top 5% of all research outputs scored by Altmetric.

    This is a significant achievement and we are very proud of your hard work. Further details can be found here:

    http://www.altmetric.com/details/10862486

    https://www.altmetric.com/details/12855020

    http://www.altmetric.com/details/12681589

    To help us boost the Altmetric Score even further please get on to Twitter and tweet or retweet about our articles. We have produced several ‘Visual Abstracts’ of the main results of our papers which you may find quite interesting and these can be found here:

    https://twitter.com/EwenGriffiths/status/800803964535132160

    https://twitter.com/EwenGriffiths/status/800808252665643009

    https://twitter.com/EwenGriffiths/status/800804983981637635

    Please feel free to use them in local presentations etc or edit them for your needs.

    Inaddition, secondary analyses from the CholeS dataset are being performed in combination with other datasets and it is likely that in 2017 we will have some further papers out of this project.

    Suggested citation format for Curriculum Vitae is the following: Bloggs J. (local collaborator / local lead / data validator [insert as appropriate]): CholeS study group, West Midlands Research Collaborative. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg. 2016 Nov;103(12):1704-1715 for example.

    PDFs of the accepted papers and abstracts can be accessed via this link: https://www.dropbox.com/sh/sdj25863vokzjsm/AACg2UFUdGA6l2C0zCs_mHt5a?dl=0 (this link may not work from hospital computers). We will update these files as the other papers get published.

    We are considering a further population based audit of gallbladder diseases and extending our study to European and Worldwide Centres – EurCholeS or GlobalCholeS perhaps. We think we can build on our protocol and data collection methods and produce an even better study. We would be very interested to hear from you about this. Especially, we would like to hear from Trainees who can help lead this project and hospitals who would be keen to participate in the data collection. Please email ewen.griffiths@uhb.nhs.uk if you are interested. It is likely that this would focus purely on patients having emergency or delayed surgery to understand more about this important group.

    The West Midlands Research Collaborative is working on another cohort study you may be interested in. This is called the RIFT ‘Right Iliac Fossa Treatment Audit’ – further details can be found here: http://wmresearch.org.uk/?page_id=573 So please do register your interest.

    Thanks again for your support.

    Kind regards,

    Ewen Griffiths and the CholeS team (Ravinder Vohra, Sandro Pasquali, Amanda Kirkham, Paul Marriott, Marianne Hollyman, Philip Spreadborough, Derek Alderson)

    On behalf of the CholeS study group WMRC

    http://www.wmresearch.org.uk – Please see the CholeS page.

    Twitter @WMRC_UK @UoBSurgery @EwenGriffiths

  2. Dear CholeS Collaborator and interested parties,
    CholeS Study: RACS presentations, ASGBI presentations (including a nomination for the Moynihan prize), accepted papers and other updates
    We thank everyone for their patience with this.
    Two papers have now been accepted for publication in the British Journal of Surgery entitled:
    1. Population based cohort study of outcomes following cholecystectomy for benign gallbladder diseases
    2. Population based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases
    These are both ‘in press’ and should appear on the BJS website in the coming month. Please see the website http://www.bjs.co.uk/ in due course for further details.
    Both papers were presented at the Royal Australasian College of Surgeons AGM in Brisbane in May and ASGBI 2016 in Belfast. The abstracts have been published in the ANZ Journal of Surgery and British Journal of Surgery, respectively.
    The paper ‘Population based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases’ was nominated for the Moynihan prize. Unfortunately, we didn’t win, but did come very close!
    In addition, three further papers are under peer review: a health economic evaluation (paper 3); a score to predict conversion (paper 4) and the effectiveness of antibiotic prophylaxis on surgical site infections (paper 5).
    PDFs of the accepted papers and abstracts can be accessed via this link: https://www.dropbox.com/sh/sdj25863vokzjsm/AACg2UFUdGA6l2C0zCs_mHt5a?dl=0 (this link may not work from hospital computers). We will update these files as the other papers get published.
    The data is helping inform a randomised control trial based on bile duct imaging and a quality improvement project run by the RCS (CholeQUIC) and AUGIS.
    Finally, we will be presenting the results of CholeS in a plenary session at AUGIS this year on Friday 23rd September. Please come along! Further details can be found at http://www.augis.org/2016conference/registration/

    We are considering a further population based audit of gallbladder diseases and extending our study to European and Worldwide Centres – EurCholeS or GlobalCholeS perhaps. We think we can build on our protocol and data collection methods and produce an even better study. We would be very interested to hear from you about this. Especially, we would like to hear from Surgical Registrars or Research Collaboratives who can help lead this project and hospitals who would be keen to participate in the data collection. Please email ewen.griffiths@uhb.nhs.uk if you are interested.
    Thanks again for your patience and support.
    Kind regards,
    Ravinder Vohra, Sandro Pasquali, Amanda Kirkham, Paul Marriott, Marianne Hollyman, Philip Spreadborough, Derek Alderson, and Ewen Griffiths
    On behalf of the CholeS study group WMRC
    http://www.wmresearch.org.uk
    Twitter @WMRC_UK

    1. Hi Philippa,
      I do not know when the CholeS report will be published. It was presented at the ASGBI meeting earlier this year and I understand that at least one paper has been submitted for publication. I will find out more at our next meeting on Monday 11th July and let you know.
      Thanks
      Richard
      WMRC Chair

    2. Hi Philippa,
      Below is a copy of an email that has been sent out from the CholeS team. It gives some details about publications etc.
      Hope you find it useful.
      Thanks
      Richard
      Dear CholeS Collaborator and interested parties,
      CholeS Study: RACS presentations, ASGBI presentations (including a nomination for the Moynihan prize), accepted papers and other updates
      We thank everyone for their patience with this.
      Two papers have now been accepted for publication in the British Journal of Surgery entitled:
      1. Population based cohort study of outcomes following cholecystectomy for benign gallbladder diseases
      2. Population based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases
      These are both ‘in press’ and should appear on the BJS website in the coming month. Please see the website http://www.bjs.co.uk/ in due course for further details.
      Both papers were presented at the Royal Australasian College of Surgeons AGM in Brisbane in May and ASGBI 2016 in Belfast. The abstracts have been published in the ANZ Journal of Surgery and British Journal of Surgery, respectively.
      The paper ‘Population based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases’ was nominated for the Moynihan prize. Unfortunately, we didn’t win, but did come very close!
      In addition, three further papers are under peer review: a health economic evaluation (paper 3); a score to predict conversion (paper 4) and the effectiveness of antibiotic prophylaxis on surgical site infections (paper 5).
      PDFs of the accepted papers and abstracts can be accessed via this link: https://www.dropbox.com/sh/sdj25863vokzjsm/AACg2UFUdGA6l2C0zCs_mHt5a?dl=0 (this link may not work from hospital computers). We will update these files as the other papers get published.
      The data is helping inform a randomised control trial based on bile duct imaging and a quality improvement project run by the RCS (CholeQUIC) and AUGIS.
      Finally, we will be presenting the results of CholeS in a plenary session at AUGIS this year on Friday 23rd September. Please come along! Further details can be found at http://www.augis.org/2016conference/registration/

      We are considering a further population based audit of gallbladder diseases and extending our study to European and Worldwide Centres – EurCholeS or GlobalCholeS perhaps. We think we can build on our protocol and data collection methods and produce an even better study. We would be very interested to hear from you about this. Especially, we would like to hear from Surgical Registrars or Research Collaboratives who can help lead this project and hospitals who would be keen to participate in the data collection. Please email ewen.griffiths@uhb.nhs.uk mailto:ewen.griffiths@uhb.nhs.uk if you are interested.
      Thanks again for your patience and support.
      Kind regards,
      Ravinder Vohra, Sandro Pasquali, Amanda Kirkham, Paul Marriott, Marianne Hollyman, Philip Spreadborough, Derek Alderson, and Ewen Griffiths
      On behalf of the CholeS study group WMRC
      http://www.wmresearch.org.uk
      Twitter @WMRC_UK

  3. Hi Guy,

    Sorry I’ve only just seen your comment. We are working on several manuscripts at the moment. I would hope we would have our first publication by the end of the year with another 3-4 during 2016. These things always take longer than we think!

    Marianne

  4. I do understand that the contribution letter is for the junior Dr involved in the study. This letter should be varified by the local consultant investigator. What about the local consultant investigator? can I use the same letter or there is another letter for the local consultant investigator.
    Best regards

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