An Acute Care Surgery Model Improves Timeliness of Care and Reduces Hospital Stay for Patients with Acute Cholecystitis

Abstract

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.

Impact of an acute care surgery model on appendicectomy outcomes

“…Only one study reported a statistically significant reduction in perforation rate . All previous studies that assessed complication rates found statistically significant decreases in complication rate with the ACS model . None of the studies found statistically significant differences in negative appendicectomy rate .…”

“…We were also disappointed to note that the introduction of an ACS model at our centre had not increased the proportion of appendicectomies performed by surgical trainees, rather than consultants or fellows (as determined by the primary operator on the operation record), as reported in prior studies examining the ACS model . We attributed this to the busy nature of work at our centre.…”

“…One study reported an increase in after‐hours procedures . Interestingly, four studies found decreases in length of stay . Only one study reported a statistically significant reduction in perforation rate .…”

“…However, it should be noted that there is considerable heterogeneity in the results from these studies. Most studies reported reductions in length of time to operation and in proportion of operations performed after‐hours . One study reported an increase in after‐hours procedures .…”

“…Acute care surgery (ACS) is a relatively new paradigm in the field of general surgery, with several institutions across the USA offering it as a specialty in its own right . The application of an ACS‐style model to handle general surgical emergencies has been trialled in several centres across the USA and Australia with mixed results . The potential benefits of such a model are based on the premise that general surgical emergencies are not unexpected but are predictable and therefore can be planned for.…”