Time and cost analysis of gallbladder surgery under the acute care surgery model

Michailidou, Maria; Kulvatunyou, Narong; Friese, Randall S.; Gries, Lynn; Green, Donald J.; Joseph, Bellal; OʼKeeffe, Terence; Tang, Andrew; Vercruysse, Gary; Rhee, Peter

doi:10.1097/ta.0000000000000117

Cited by 48 publications

(24 citation statements)

References 15 publications

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“…There is good evidence that dedicated EGS surgeons can improve a variety of outcomes for patients with appendicitis [11,12] and gallstone disease [12][13][14][15]. However, a number of papers in the literature express concern about the outcomes of more specialized procedures, particularly colorectal resection [16][17][18][19][20][21] and gastrectomy [22].…”

Section: Introductionmentioning

confidence: 99%

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

et al. 2018

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Aim This study aimed to survey consultants’ experience of working as or with emergency general surgery (EGS) surgeons and to investigate the role they fulfil in the management of general and subspeciality emergencies. Method An electronic survey, designed to capture both quantitative and qualitative data, was piloted and then circulated to members of the Association of Coloproctology of Great Britain and Ireland. Results Two hundred and forty‐two responses were received from 848 recipients (a 29% response rate) covering 104 of 135 (77%) acute NHS Trusts in England. EGS surgeons were in post in 43/141 (30%) hospitals overall and 12/24 (50%) of hospitals in London. Most respondents working in units with EGS surgeons found them to be advantageous (46/63, 73%). Consultants working with EGS surgeons were significantly more likely to support their use (49/63, 78%) than those without them (83/178, 47%) (χ2 = 16.9, P < 0.001). EGS surgeons were considered to improve the delivery of EGS (78%), create time for subspecialists (70%) and provide service (73%). However, there were concerns about the quality of surgery (43%), an insufficient standard of specialist care (54%) and compromise in the training of juniors (25%). Respondents commented on a lack of job structure with a high attrition rate (21%), the insufficient quality of applicants (18%) and that subspecialization and split on‐call was preferable (17%). Conclusion Respondents were supportive of the ability of EGS surgeons to relieve pressure on subspecialists; however, there were significant concerns about the sustainability and quality of the EGS surgeon role. Emergency colorectal resections should have the input of a surgeon who performs elective colorectal resections.

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Section: Introductionmentioning

confidence: 99%

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

et al. 2018

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“…We obtained a rate of 76% without a subsequent increase in after-hours or weekend operations. Reports of operative timing for acute cholecystitis vary with some centers reporting an increase in after-hours/weekend operations [38], and others reporting a decrease [5, 9, 11]. Unfortunately, the role of a dedicated operating room is challenging to discern as the reporting on the design of the ACS services in the collective literature is generally poor.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…One study concluded that ACS model adoption led to decreased hospital costs in the surgical treatment of gallbladder disease (31). Other studies have reported that large, urban, teaching, Level 1 trauma hospitals with a substantial population of ACS patients were more likely to have higher charges compared to rural hospitals and those without defined ACS departments (32, 33).…”

Section: Discussionmentioning

confidence: 99%

The impact of acute care surgery on appendicitis outcomes

Madore

Collins²,

Aytürk³

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background Acute appendicitis is the most common indication for emergency general surgery (EGS) in the US. We examined the role of acute care surgery (ACS) on interventions and outcomes for acute appendicitis at a national sample of university-affiliated hospitals. Methods We surveyed senior surgeons responsible for EGS coverage at University HealthSystems Consortium (UHC) hospitals, representing >90% of university-affiliated hospitals in the US. The survey elicited data on resources allocated for EGS during 2013. Responses were linked to UHC outcomes data by unique hospital identifiers. Patients treated at hospitals reporting hybrid models for EGS coverage were excluded. Differences in interventions and outcomes between patients with acute appendicitis treated at ACS hospitals vs. hospitals with a general surgeon on-call model (GSOC) were analyzed using univariate comparisons and multivariable logistic regression models adjusted for patient demographics, clinical acuity, and hospital characteristics. Results We found 122 hospitals meeting criteria for analysis where 2,565 patients were treated for acute appendicitis. 48% of hospitals had an ACS model (N =1414), and 52% had a GSOC model (N=1151). Hospitals with ACS models were more likely to treat minority patients with greater severity of illness than GSOC models. Patients treated at ACS hospitals were more likely to undergo laparoscopic appendectomy. In multivariable modeling of patients who had surgery (N=2,258), patients treated at ACS hospitals had 1.86 [95%CI 1.23,2.80] greater odds of undergoing laparoscopic appendectomy. Conclusion In an era when laparoscopic appendectomy is increasingly accepted for treating uncomplicated acute appendicitis, particularly in low risk patients, it is concerning that patients treated at GSOC model hospitals are more likely to undergo traditional open surgery despite having less severity of illness at the time of presentation. Furthermore, hospitals with ACS are functioning as safety net hospitals for vulnerable patients with acute appendicitis. Level of Evidence III

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Time and cost analysis of gallbladder surgery under the acute care surgery model

Abstract: Therapeutic study, level IV.

Cited by 48 publications

References 15 publications

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

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

The impact of acute care surgery on appendicitis outcomes

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