Sara E Martin del Campo, MD, MS, David S Strosberg, MD, MS, Andrew J Suzo, BS, CCRP, Rebecca R Dettorre, MA, CCRC, Sara A Mansfield, MD, MS, Jeffrey W Hazey, MD, Bradley J Needleman, MD. The Ohio State University Wexner Medical Center
Introduction: The acute care surgery (ACS) model is a relatively new concept implemented in surgical departments to provide care to patients with urgent surgical needs. The objective of this study was to investigate the outcomes of those undergoing cholecystectomy by acute care surgeons compared to those performed by non-ACS general surgeons.
Methods: An IRB-approved, retrospective review was conducted of all non-cancer patients who underwent cholecystectomy between July 2012 and June 2015 in an academic health system. Data collected included service, demographics and history, operative details, post-operative complications, and costs. Data are presented as incidence (%) or mean ± SD, and a p-value of <0.05 was considered statistically significant.
Results: 2001 patients underwent cholecystectomy during the three-year time period. ACS performed 516 cholecystectomies, and 1485 were performed by non-ACS general surgeons. The two groups were similar in age, BMI, and history of previous laparotomy. Females comprised 53.9% of the ACS patients, but 72.6% of the non-ACS patients. The pre-operative diagnoses included more acute cholecystitis (41.2% vs. 12.1%; p<0.01), gallstone pancreatitis (11.37% vs. 4.66%; p<0.01) and choledocholithiasis (10.58% vs 4.78%; p<0.01) in the ACS group compared to the non-ACS group, respectively. There was a greater proportion of cases performed open (9.5% vs. 5.3%) or converted to open (14.3% vs 2.4%) for the ACS group, and longer operative times (1.79 hours vs. 1.27 hours; p<0.001). The rate of post-operative complications was 13.2% in the ACS group and 4.9% in the non-ACS group, including bile leaks (2.28% vs. 0.60%; p<0.001), common bile duct injuries (0.57% vs. 0.40%; p=0.60) and bleeding (3.41% vs. 0.74%; p<0.001) for ACS compared to non-ACS operations, respectively. Post-operative length of stay was 3.9 ± 5.8 days for the ACS group compared to 1.4 ± 3.7 days for the non-ACS group. Total charges for the index hospitalization was $79,369 ± $125,848 for the ACS group compared to $40,866 ± $64,011 for the non-ACS group (p<0.0001).
Conclusions: The acute care surgery model was adopted to meet a need for in-house emergency general surgery procedures. This study demonstrates that in the setting of cholecystectomy, compared to other general surgeons in a large academic health system, ACS performs a greater percentage of non-elective cases for acute gallbladder problems with a higher complication rate, longer operative times, longer length of stay, and at a greater cost, perhaps due to the higher acuity of patients and the gallbladder diseases encountered.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79636
Program Number: P087
Presentation Session: Poster (Non CME)
Presentation Type: Poster