Acute care surgery: a means for providing cost-effective, quality care for gallstone pancreatitis

Abstract

BackgroundModern practice guidelines recommend index cholecystectomy (IC) for patients admitted with gallstone pancreatitis (GSP). However, this benchmark has been difficult to widely achieve. Previous work has demonstrated that dedicated acute care surgery (ACS) services can facilitate IC. However, the associated financial costs and economic effectiveness of this intervention are unknown and represent potential barriers to ACS adoption. We investigated the impact of an ACS service at two hospitals before and after implementation on cost effectiveness, patient quality-adjusted life years (QALY) and impact on rates of IC.MethodsAll patients admitted with non-severe GSP to two tertiary care teaching hospitals from January 2008–May 2015 were reviewed. The diagnosis of GSP was confirmed upon review of clinical, biochemical and radiographic criteria. Patients were divided into three time periods based on the presence of ACS (none, at one hospital, at both hospitals). Data were collected regarding demographics, cholecystectomy timing, resource utilization, and associated costs. QALY analyses were performed and incremental cost effectiveness ratios were calculated comparing pre-ACS to post-ACS periods.ResultsIn 435 patients admitted for GSP, IC increased from 16 to 76% after implementing an ACS service at both hospitals. There was a significant reduction in admissions and emergency room visits for GSP after introduction of ACS services (p < 0.001). There was no difference in length of stay or conversion to an open operation. The implementation of the ACS service was associated with a decrease in cost of $1162 per patient undergoing cholecystectomy, representing a 12.6% savings.The time period with both hospitals having established ACS services resulted in a highly favorable cost to quality-adjusted life year ratio (QALY gained and financial costs decreased).ConclusionsACS services facilitate cost-effective management of GSP. The result is improved and timelier patient care with decreased healthcare costs. Hospitals without a dedicated ACS service should strongly consider adopting this model of care.

Index cholecystectomy rates in mild gallstone pancreatitis: a single‐centre experience

“…6 However, it must be taken into account that during the study period Queensland Health, by contract, had beds and theatre access at the co-located private hospital SCUPH. Given that theatre access is often reported as a significant factor preventing IAC 17,18 and that over half of the IACs were performed in the private sector, the 69.5% rate likely represents the upper limit of current adherence. Whether this public/private model of care presents an opportunity as a more permanent solution to theatre access issues would require further research, but it would likely be financially viable given the expected savings to hospital bed days and representation.…”

Acute Care Surgery Model and Outcomes in Emergency General Surgery

“…Since its introduction in the early 2000s, many centers have moved toward establishing an acute care surgery model for the care of emergency general surgery patients. [1][2][3][12][13][14][15] Individual centers have reported improved select EGS patient outcomes after development of an ACS service compared with historical cohorts [16][17][18] or between a small number of affiliated institutions. 19 To our knowledge, this is the first study to evaluate the correlation between patient care model and contemporaneous EGS patient outcomes across multiple institutions using a prospectively collected patient outcomes data registry.…”

Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis

“…While fully implementing the changes to facilitate easy access to EC may require investment in the short term, it will be associated with an increase in long‐term cost‐effectiveness. An analysis by Murphy and co‐workers found that reconfiguration of services, to increase the delivery of EC, resulted in savings of 12·6 per cent per patient as a result of avoiding readmission.…”