Impact of medical or surgical admission on outcomes of patients with acute cholecystitis

Macedo, Francisco Igor B.; Eid, Joseph J.; Mittal, Vijay K.; Flynn, Jeffrey C.; Jacobs, Michael J.; Pearlman, Ralph

doi:10.1016/j.hpb.2016.11.007

Cited by 5 publications

(8 citation statements)

References 28 publications

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“…Medical patients (ie, patients admitted to the hospital for an acute medical condition) are very different from surgical patients who are admitted to the hospital to undergo a procedure. 12 , 13 Planned surgical procedures offer an opportunity for preoperative interventions to reduce a patient’s risk of adverse outcomes after surgery. Examples include “prehabilitation” and Enhanced Recovery After Surgery (ERAS) programs.…”

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confidence: 99%

Psychosocial Determinants of Readmission After Surgery

et al. 2021

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Background: Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood. Objective: We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population. Research Design: This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital. Subjects: We include Veterans undergoing elective inpatient general, vascular, or thoracic surgery (August 1, 2015–June 30, 2017). Measures: We assessed unplanned readmission to any medical facility within 30 days of hospital discharge. Results: A total of 736 patients completed the 30-day postoperative follow-up, and 16.3% experienced readmission. Lower patient-reported physical and mental health, inadequate health literacy, and discharge home with help after surgery or to a skilled nursing or rehabilitation facility were associated with an increased incidence of readmission. Classification regression identified the patient-reported Veterans Short Form 12 (SF12) Mental Component Score <31 as the most important psychosocial determinant of readmission after surgery. Conclusions: Mental health concerns, inadequate health literacy, and lower social support after hospital discharge are significant predictors of increased unplanned readmissions after major general, vascular, or thoracic surgery. These elements should be incorporated into routinely collected electronic health record data. Also, discharge plans should accommodate varying levels of health literacy and consider how the patient’s mental health and social support needs will affect recovery.

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confidence: 99%

Psychosocial Determinants of Readmission After Surgery

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…The authors believe that this is a testament of the robustness of a dedicated gastrointestinal bleeding service. For several other conditions which were historically of a surgical nature, such as gallstone pancreatitis, 28 acute cholecystitis 29 and small bowel obstruction due to adhesions, [30][31][32] admission under a surgical discipline were associated with decreased morbidity and mortality. [28][29][30][31][32] Aquina et al, who investigated the impact of admission discipline for patients with adhesive small bowel obstruction postulated that the differences in outcomes between a medical and surgical admission might be due to a reduced time to surgical intervention for patients that were initially managed by surgeons.…”

Section: Discussionmentioning

confidence: 99%

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

Chue

Boey

et al. 2021

ANZ Journal of Surgery

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Background: Bleeding of the gastrointestinal tract (BGIT) is a common gastrointestinal emergency. There is no consensus whether this condition should be admitted to medical or surgical discipline. Timing of presentation may also impact patient outcomes due to differences in healthcare resource availability. This study thus aims to investigate the impact of admitting discipline and timing of admission on patient outcomes in BGIT. Methods: A 2-year tertiary institution database was retrospectively reviewed. Outcome measures included 30-day mortality, 30-day readmissions and rebleeding requiring repeat endoscopic, angiographic or surgical interventions. Secondary outcome measures included time to endoscopy, percutaneous angiographic interventions and surgery. The effect of admission discipline (medical versus surgical) and time of admission (office-hours versus after office-hours) were analysed using a propensity-score-adjusted estimate. Results: A total of 1384 patients were included for analysis, medical (n = 853), surgical (n = 530); during office-hours (n = 785) and after office-hours (n = 595). After propensityscore-adjusted analysis, no significant differences in mortality or readmissions were noted between medical or surgical admissions. Patients admitted under surgery were less likely to sustain rebleeding (P = 0.004) for lower BGIT and had an earlier time to endoscopy for upper BGIT (P = 0.04). Patients admitted after office-hours had similar outcomes with those admitted during office hours apart from a delay in time to endoscopy (P = 0.02). Conclusion:For BGIT patients, admission to a surgical discipline compared to a medical discipline appeared to have at least equivalent patient outcomes. Patients presenting with BGIT after office-hours were more likely to experience a delay to endoscopy, although it did not affect patient mortality.

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“…20 Medical patients with surgical complications have an increased mortality and length of stay compared with medical patients with no surgical pathology; this could be attributed to multiple factors: patients having multiple organ systems involvement; being more unwell at presentation with higher CRP and poorer kidney function; and being treated by a team that lacks the expertise to diagnose and treat surgical problems. 21 Interestingly, medical patients with surgical pathology also have poorer prognosis than patients only presenting with emergency general surgical pathology. Previous studies reported mortality rates between 15% and 23% in patients undergoing emergency general surgical intervention.…”

Section: Meaning Of the Study: Possible Mechanisms And Implications F...mentioning

confidence: 99%

Factors associated with the development of acute general surgical pathology in medical inpatients

Sarathy

Veysey

2022

Internal Medicine Journal

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Background: Medical inpatients can develop acute general surgical conditions. However, this is rare. The presence of multiple acute pathologies delays diagnosis and these patients have poorer prognoses.Aim: To determine the incidence, risk factors and prognosis of medical inpatients developing acute general surgical conditions.Methods: A single-centre retrospective case-control study was conducted over 1 year in the United Kingdom. Medical patients developing acute surgical pathology were identified using the local referral system. For each case, two controls were selected from a pool of medical inpatients receiving no general surgical input during their admission. Patient records were used to collect hospital admission details, demographic and laboratory data. Univariate analysis and multivariable analysis were performed. Results:The study included 42 cases and 84 controls. The incidence of general surgical pathology in medical inpatients was 2.3/1000 admissions/year. In multivariate analysis, risk factors associated with developing general surgical pathology were previous abdominal surgery (odds ratio (OR) =3.68; 95% confidence interval (CI): 1.43 to 9.48; P = 0.007) and doubling from baseline creatinine (OR = 18.9; 95% CI: 2.57 to 139; P = 0.004). Patients with surgical pathology had longer inpatient stays (22.8 vs 9.4 days; P < 0.001) and a higher inpatient mortality (23.8% vs 7.1%; P = 0.011). Development of surgical pathology was strongly associated with mortality (OR = 4.06; 95% CI: 1.36 to 12.1). Conclusion:The development of acute surgical pathology in medical inpatients is rare but associated with longer inpatient stays and higher mortality. We have identified risk-factors associated with the development of surgical pathology, which can be used to identify patients at risk of surgical pathology.

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Impact of medical or surgical admission on outcomes of patients with acute cholecystitis

Abstract: Patients under 70 years old with AC undergoing cholecystectomy admitted to MS had increased LOS, delay to the operation, and hospital costs compared to those admitted to a SS. Admission of patients with AC to a SS needs to be emphasized to reduce costs and improve quality of care.

Cited by 5 publications

References 28 publications

Psychosocial Determinants of Readmission After Surgery

Psychosocial Determinants of Readmission After Surgery

Admission discipline and timing of admission may influence outcomes for gastrointestinal bleeding patients

Factors associated with the development of acute general surgical pathology in medical inpatients

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