FTP6.2 Utility of Ultrasound Imaging in a Successful Ambulatory Emergency Surgical Unit

Aim

Drives towards ambulatory management in emergency surgery have been supported by same day imaging to expedite decision making. We aimed to assess the frequency of surgical pathology identified by ultrasound, and subsequent requirement for operation.

Methods

All acute general surgery referrals to the ambulatory clinic of a large District General Hospital between 01/01/2021 and 22/07/2022 were included. Information regarding presentation, imaging, and diagnosis were collected in prospectively maintained databases, and subsequently analysed.

Results

Over an 18-month period, 3154 patients were seen, with a 91.7% successful ambulation rate (n=2938). 1099 patients (34.8%) underwent ultrasound, the majority were upper abdominal (63.7%, n=698); a further 33.1% (n=364) were pelvic.

Ultrasound diagnosis was suggested in 52.7% of scans (n=588); upper abdominal ultrasound provided a diagnosis in 54.9% (383/698), compared to 28.8% (105/364) of pelvic ultrasounds (p<0.001).

61 patients (5.6%) were admitted following ultrasound, of whom 36% (n=22) had no ultrasound diagnosis. Admission rate for diagnostic ultrasound was 6.9% (39/567).

Some 204 (18.6%) patients proceeded to operation; 25 (2.3%) underwent an emergency operation, 88 (8%) were operated on ambulatory lists, and 91 (8.3%) were listed electively.

Conclusions

Ultrasound is a commonly used adjunct in the ambulatory setting, particularly for assessment of biliary pathology. It has an acceptably high pathology pick up rate, and significant proportions go on to require surgical intervention, which can be ambulatory for the majority.