Acute surgical unit safely reduces unnecessary after-hours cholecystectomy

Acute surgical unit safely reduces unnecessary after-hours cholecystectomy

The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care. A retro...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England Vol. 97; no. 8; pp. 568 - 573
Main Authors: Suhardja, T S, Bae, L, Seah, E Z, Cashin, P, Croagh, D G
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01-11-2015
Royal College of Surgeons
Subjects:
Adolescent
Adult
After-Hours Care - methods
Age
Aged
Aged, 80 and over
Appendicitis
Cholecystectomy
Cholecystectomy - statistics & numerical data
Cholecystitis, Acute - surgery
Cost control
Demographics
Emergency medical care
Female
Follow-Up Studies
Gallbladder
Gallbladder diseases
Gallstones
Hospital costs
HPB surgery
Humans
Laparoscopy
Male
Middle Aged
Pancreatitis
Patients
Retrospective Studies
Statistical analysis
Surgeons
Surgery
Surgical outcomes
Surgicenters - standards
Unnecessary Procedures - trends
Young Adult
Australia
Cholecystectomy
Gallbladder diseases
General surgery
Cholecystitis
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Summary:The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care. A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm - 8am), length of stay and surgical complications. A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p<0.001) and the median length of stay (4 vs 3 days, p<0.001). The median operating time, rate of conversion to open cholecystectomy and wound infection rates remained similar. Implementation of an ASU can lead to objective differences in outcomes for patients who present with acute cholecystitis. In our study, the ASU significantly reduced time to operation, the number of operations performed after hours and length of stay.
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ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2015.0035