V. Sandoval1, J. T. Brady1, M. E. Kelly2, S. R. Steele1, V. P. Ho1 1University Hospitals Case Medical Center,Surgery,Cleveland, OH, USA 2Case Western Reserve University School Of Medicine,Cleveland, OH, USA
Introduction: Benign gallstone disease is a common problem that becomes symptomatic in a minority of patients, but remains associated with significant health care utilization and costs. These patients can be admitted to a surgical or non-surgical (“medical”) team, but not much is known about the impact of this on patient outcomes in the current model of Acute Care Surgery (ACS) services.
Methods: We performed a retrospective review of patients who underwent cholecystectomy by the ACS service at a tertiary care academic medical center from 7/2013 to 6/2015. Patient were identified by Current Procedural Terminology codes for open or laparoscopic cholecystectomy, percutaneous cholecystostomy or ERCP. Patients who underwent cholecystectomy during the index admission were grouped based on admitting service (ACS vs. medicine). Other data points collected included date of admission, date of surgery consult, diagnostic tests performed, and length of stay Continuous variables were compared using Student’s t test and categorical variables compared using Chi square or Fisher’s exact test where appropriate.
Results: We identified 85 patients during the study period who underwent cholecystectomy, of whom 51.8% (n=44) were admitted to the ACS service. The majority of the patients in the ACS and medicine groups were female (84.1% vs. 75.6%, respectively, P=0.33). Mean age was similar in both groups (ACS: 43.1±20.9 vs. medicine: 49.2±19.2, P=0.17). There were significantly more patients admitted to a medical service who were transferred from an outside facility (43.9% vs. 13.6%, P=0.002). The mean number of days from arrival at the hospital to surgery consult was 0.9±0.2 days in the medicine group. The mean number of days from ACS consult or admission to ACS to procedure date was similar (2.4±1.3 vs. 2.7±1.9, P=0.37). The number of diagnostic tests overall including CT, Ultrasound, HIDA scan and ERCP was similar between groups (ACS: 1.9±1.1 vs. medicine: 2.3±1.1, P=0.09). Significantly more patients in the medical admission group had acute pancreatitis on admission (51.2% vs. 9.1%, P=<0.001). There was no significant difference in the percentage of patients who underwent a laparoscopic approach between groups (ACS: 93.2% vs. medicine: 82.9%, P=0.14). There was an overall decreased length of stay by 1.2 days in the ACS group but it did not reach statistical significance (5.4±2.6 vs. 6.6±2.9, P=.052).
Conclusion: This study suggests that patients who underwent cholecystectomy and were admitted to the ACS service had a 1 day shorter length of stay compared to patients admitted to a medical service and for which ACS was consulted. Implementing policies that favor admission to a surgery service could lead to decreased costs for patients.