Trends and outcome of emergency cholecystectomy in yekatit 12 hospital

medical college

Principal Investigator: Tolera kebede (MD,GSR)

Advisors: Dr Getachew (MD,associate professor of hepatobiliary

surgeon)
Mr. Alemu kibret ( MPH)
December 21, 2021

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 Presentation Outline
• Introduction
• Statement of the Problem
• Significance of the Study
• Objectives
• Methods and Materials
• Work plan
• Budget Breakdown
• Reference
• Acknowledgement

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 1. Introduction
• Cholecystectomy is one the most common gastrointestinal
operation performed in the western countries (Gaillard M,2015)

• It is also the most common elective surgical procedure in Addis

Ababa, second to thyroid surgery (Gebresellassie H, 2019)

• Emergency cholecystectomy is the gold standard of treatment for

acute cholecystitits (Thangavelu A,2018)
• The utilization of emergency cholecystectomy is 78.7% in US
(Wadhwa V, 2021)

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 2. Statement of the Problem

• Gallstones are public health problems in Ethiopia. The overall prevalence of

gall stone diseases among Hospital admitted patients in referral Hospital of
Ethiopia 10.5%. (Alelign T,2019)and accounts for 25.9% of all Gastro
Intestinal Unit admissions in Tikur Anbessa Hospital(Adem A ,2001)

• Acute cholecystits develops in 1-3% patients with symptomatic gall stone.

(Csikesz N,2010)

• Globally, emergency cholecystectomy emerged as an option for treatment of

acute cholecystitis in 1980’s (Al-Khuwaitir,1985)

• In Africa not much is known about emergency cholecystectomy.

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 3. Significance of the Study

•Limited studies on the topic done in Ethiopia

•majority were focused on elective cholecystectomy

•It is a new experience in our hospital , so outcome should be determined

to standardize it as the hospital management protocol

•Used as baseline/standard for other hospital

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 conceptual frame work

Treatment related
Sociodemograph factors
ic factors Timing of surgery
Duration of surgery
Age , sex
Intraop accident

Disease related factors

Duration of illness Outcome
Comorbidity
Favorable /unfavorable
ASA class
Grade of acute cholecystitis

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 4. Objectives

4.1 General Objective

To assess trends and outcomes of emergency cholecystectomy among
Yekatit 12 surgical patients admitted with acute cholecystitis.

4.2 Specific Objectives

To assess trends of emergency cholecystectomy

To assess outcomes of emergency cholecystectomy

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 5. Methods and Materials
5.1. Study Area and period
 The study will be conducted at Yekatit 12 HMC Addis Ababa, Ethiopia

 Employees = >1,400; Total bed = 419; surgical ward bed = 52 serving an annual
catchment population of 230,000
 The study will be conducted among patients with diagnosis of acute cholecystitis
admitted from January 1st to December 31st 2022

5.2. Source and Study Population

 Source population: all patients admitted to Yekatit 12 HMC surgical ward on
emergency basis

 Study population: all patients admitted to Yekatit 12 HMC with diagnosis of acute

12/21/2021 cholecystitis admitted from January 1st to December 31st 2022 8

 5. Methods and Materials Ctd…
5.3. Inclusion and Exclusion Criteria
5.3.1. Inclusion Criteria
Age ≥18 years
All patients with acute cholecystitis

5.3.2. Exclusion Criteria

Left against medical advice

Incomplete record

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 n=Z2P(1−P)d2 
5. Methods and Materials Ctd…

5.4. Study Design

A prospective cohort

5.5. Sampling Size Calculation

 all patients admitted to ward with acute cholecystitis will be included in

the study

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 5. Methods and Materials Ctd…
5.6. Data Collection Instruments and Techniques
 Data will be filled on pre structured questionaries'

5.7 Operational Definitions

 Emergency cholecystectomy : cholecystectomy done on index admission

 Early cholecystectomy: operation within 72 h of symptom onset

 Late cholecystectomy: operation after 72 h of symptom onset

 Favorable outcome: Patients for whom emergency cholecystectomy done improved and discharged
from the hospital and hospital stay developed no intraop and postoperative complication.
 Unfavorable outcome: Patients for whom emergency cholecystectomy done who improved but
developed one or more intraop or postoperative complication or patients who have died in the intra-
or post-operative period.
 Outcomes: morbidity and in-hospital mortality

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 5. Methods and Materials Ctd…
5.8. Data Quality Management
 The checklist was developed by reviewing pertinent literatures on the topic

 Pre test will be undertaken

5.9. Data Analysis and Presentation

 Data will be entered in and analyzed using SPSS version 25.0.
 Patients will be divided into those who undergone emergency cholecystectomy and those
who treated medically
 For continuous variables, mean and standard deviation (±SD) will be used while
percentages will be utilized for categorical variables

 multivariate regression will be computed from the dependent variables

 results will be analyzed and presented via a combination of textual, tabular and graphic

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5.10. Study Variables

Independent variables
Dependent variables
Sociodemographic
 Age and Sex Out come
Disease related factors  Morbidity
 Duration of illness
 Comorbidity
 Mortality
 ASA class
 Grade of acute cholecystitis
 Treatment related factors

• Timing of surgery

• Duration of surgery

• Intraop accident

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 6. Ethical Clearance

Ethical clearance will be obtained from the Ethical review committee of

Yekatit 12 Hospital medical college, Department of surgery.

Institutional written approved consent will be secured from the college

research publication office before the commencement of the data collection.

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 7. Work Plan

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 8. Budget Breakdown
SN Item unit Quantity Unit price in ETB Total price in ETB

1 Lexi Pen PK 1 500 500

2 Pencil PK 1 100 100

3 Eraser and Sharpener Each 16 12 192

4 Flashdisk Each 3 400 1200

4 Note Book PK 3 40 120

6 photocopy page 1500 1 1500

7 Duplicating paper Ream 5 150 750

8 For printing page 50 3 150

9 Payment for data collectors Questionaries’ 80 200 16000

10 supervisor Questionaries 80 300 24000

11 Payment for data entry Questionaries 80 150 12000

12 Data containing bag Quantity 3 600 1800

13 Internet 2 mb/s 5 months 800 4000

14 Contingency (10%)        

  68,543.2

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 References
1. Gaillard, M., Tranchart, H., Lainas, P. and Dagher, I., 2015. New
minimally invasive approaches for cholecystectomy: review of
literature. World journal of gastrointestinal surgery, 7(10), p.243.
2. Gebresellassie, H.W. and Tamerat, G., 2019. Audit of surgical
services in a teaching hospital in Addis Ababa, Ethiopia. BMC
research notes, 12(1).
3. Thangavelu, A., Rosenbaum, S., & Thangavelu, D. (2018).
Timing of Cholecystectomy in Acute Cholecystitis. The Journal
of emergency medicine, 54(6), 892–897.
4. Wadhwa, V., Trivedi, P. S., Makary, M. S., Strain, D. V., Ahmed,
O., Chick, J. F. B., & Charalel, R. A. (2021). Utilization and
outcomes of cholecystostomy and cholecystectomy in patients
admitted with acute cholecystitis: a nationwide
analysis. American Journal of Roentgenology, 216(6), 1558-1565.
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 References
5. Alelign, T., Debella, A., Tessema, T. S., & Petros, B. (2019).
Thirteen Years Trend in the Magnitude of Urolithiasis and
Cholelithiasis in Ethiopia: Evidence from Hospital-Based
Retrospective Study.
6. Adem A., Abebe A., Abdurahman M, Pattern of surgical
admissions to Tikur Anbessa Hospital, Addis Ababa, Ethiopia. East
and Central Africa Journal of Surgery V6 No 1, 2001
7. Csikesz, N.G., Singla, A., Murphy, M.M., Tseng, J.F. and Shah,
S.A., 2010. Surgeon volume metrics in laparoscopic
cholecystectomy. Digestive diseases and sciences, 55(8), pp.2398-
2405..
8. Friedman, G.D., 1993. Natural history of asymptomatic and
symptomatic gallstones. The American journal of surgery, 165(4),
pp.399-404.
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 Acknowledgement
• I would like to extend my sincere gratitude to my advisors Mr. Alemu, Dr
Getachew for their support, encouragement and guidance while drafting this
proposal. I must also thank the Department of general surgery at Yekatit 12
Hospital Medical College for providing me with such an opportunity to
further my knowledge on the subject matter through this research

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 Thank You!!!

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