In October 2009, an acute care surgery (ACS) model was implemented to facilitate urgent surgical consults. This study examines the impact of ACS on the timeliness of care and length of hospitalization for patients with acute cholecystitis. A retrospective cohort study was performed of patients presenting to the emergency department (ED) with acute cholecystitis who underwent early cholecystectomy. Patients with choledocholithiasis, pancreatitis, biliary colic, or cholelithiasis without cholecystitis were excluded. There were two study cohorts: ACS (October 2009 to July 2010) and pre-ACS (October 2008 to September 2009). Primary outcome measures were length of stay (LOS) and time from the ED to the operating room (OR). One hundred fifty-two cases were identified: 71 in the ACS group and 81 in the pre-ACS group. Patient demographics were similar. The ACS group had a significantly shorter average time from the ED to the OR (24.6 vs 35.0 hours, P = 0.0276). Overall LOS was reduced by a mean of 14.7 hours in the ACS group (mean 3.23 vs 2.63 days, P = 0.11). There was no significant difference in OR time (2.45 vs 2.38 hours, P = 0.562). There was a significant decrease in after-hours cases in the ACS group (5.6 vs 21%, P = 0.004) and a decrease in complication rates (18.5 vs 7.0%, P = 0.032). In conclusion, the ACS model decreased time from the ED to the OR, decreased after-hours cases, decreased length of hospitalization, and decreased complications for patients with acute cholecystitis.
Get full access to this article
View all access options for this article.
References
1.
The Committee on Acute Care Surgery American Association for the Surgery of Trauma. The acute care surgery curriculum.J Trauma Inj Infect Crit Care2007; 62: 553–6.
2.
HoytD.B., KimH.D., BarriosC.Acute care surgery: a new training and practice model in the United States.World J Surg2008; 32: 1630–5.
3.
VelmahosG.C., JurkovichG.J.The concept of acute care surgery.Surgery2007; 141: 288–90.
4.
ParasynA.D., TruskettP.G., BennettM.Acute-care surgical service: a change in culture.ANZ J Surg2009; 79: 12–8.
5.
ReillyP.M., SchwabC.W.Acute care surgery: the academic hospital's perspective.Surgery2007; 141: 299–301.
6.
EndorfF.W., JurkovichG.J.Acute care surgery: a proposed training model for a new specialty within general surgery.J Surg Educ2007; 64: 294–9.
7.
BrittR.C., WeireterL.J., BrittL.D.Initial implementation of an acute care surgery model: Implications for timeliness of care.J Am Coll Surg2009; 209: 421–4.
8.
BallC., HameedS.M., BrennemanF.D.Acute care surgery: a new strategy for the general surgery patients left behind.Can J Surg2010; 53: 84–5.
9.
MalangoniM.A.Acute care surgery: the general surgeon's perspective.Surgery2007; 141: 324–6.
10.
US Department of Health & Human Services Agency for Healthcare Research and Quality. Available at: http://hcupnet.ahrq.gov/. Accessed August 1, 2010.
CasillasR.A., YegiyantsS., CollinsJ.C.Early laparoscopic cholecystectomy is the preferred management of acute cholecystitis.Arch Surg2008; 143: 533–7.
13.
Al-MulhimA.A.Timing of early laparoscopic cholecystectomy for acute cholecystitis.J Soc Laparoendosc Surg2008; 12: 282–7.
14.
SiddiquiT., MacDonaldA., ChongP.S., JenkinsJ.T.Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials.Am J Surg2008; 195: 40–7.
15.
Gonzalez-RodriguezF.J., Paredes-CotoréJ.P., PontónC.Early or delayed laparoscopic cholecystectomy in acute cholecystitis? Conclusions of a controlled trial.Hepatogastroenterology2009; 56: 11–6.
16.
LauH., LoC.Y., PatilN.G., YuenW.K.Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis.Surg Endosc2006; 20: 82–7.
17.
KuwabaharaK., MatsudaS., FushimiK.Impact of timing of cholecystectomy and bile duct intervention on quality of cholecystitis care.Int J Surg2009; 7: 243–9.
18.
BrittR.C., BouchardC., WeireterL.J., BrittL.D.Impact of acute care surgery on biliary disease.J Am Coll Surg2010210: 595–9, 599–601.
19.
LehaneC.W., JootunR.N., BennettM.Does and acute care surgery model improve the management and outcome of cholecystitis.ANZ J Surg2010; 80: 438–42.
20.
CataniM., De MilitoR., RomagnoliF.The best timing of surgery in laparoscopic cholecystectomy for acute cholecystitis: when and how is to be performed.Hepatogastroenterology2008; 55: 1993–6.
21.
HadadS.M., VaidyaJ.S., BakerL.Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis.World J Surg2007; 31: 1298–301.
22.
WilsonE., GurusamyK., GluudC., DavidsonB.R.Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Br J Surg2010; 97: 210–9.
