Acute surgical unit safely reduces unnecessary after-hours cholecystectomy

Abstract

INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Acute calculus cholecystitis: commentary on Tokyo Guidelines 2018

“…Finally, we agree with Okamoto et al in suggesting the best expertise/hospital capability in facing difficult cases of acute cholecystitis. However, we like to support the notion that the acute surgical model, moreso than the extremely specialized one, offers the best answer for acute cholecystitis .…”

Outcomes of an acute care surgery model: a 10‐year follow‐up study

“…Numerous ACS models have since been implemented by hospitals across Australia and New Zealand with comparable impacts. Most studies have demonstrated a reduction in after‐hours or overnight operating . For non‐elective appendicectomy, wait times to surgery and lengths of stay were either reduced or unchanged, as were rates of perforated appendicitis .…”

“…Most studies have demonstrated a reduction in after-hours or overnight operating. [4][5][6][7][8][9][10][11][12][13] For non-elective appendicectomy, wait times to surgery and lengths of stay were either reduced or unchanged, [4][5][6][7][8]12,14 as were rates of perforated appendicitis. [4][5][6][7]14 Complication rates were reduced 5 or unchanged.…”

“…[4][5][6][7]14 Complication rates were reduced 5 or unchanged. 6,14 For non-elective cholecystectomy, wait times to surgery and lengths of stay were usually reduced following the implementation of an ACS model, 10,15 although most studies reported no difference in the complication rate. 9,10,15 Most studies used a repeated cross-sectional design to assess the immediate impact of implementing an ACS model, but few have provided data on whether these outcomes have endured.…”

“…6,14 For non-elective cholecystectomy, wait times to surgery and lengths of stay were usually reduced following the implementation of an ACS model, 10,15 although most studies reported no difference in the complication rate. 9,10,15 Most studies used a repeated cross-sectional design to assess the immediate impact of implementing an ACS model, but few have provided data on whether these outcomes have endured. It is possible that improvements only last during the period of change following the introduction of a new system due to increased surveillance and staff awareness, a phenomenon known as the Hawthorne effect.…”