Larsa Al-Omaishi, BS, William S Richardson, MD. Ochsner Medical Clinic Foundation
Introduction: The acute care surgery (ACS) model, defined as a dedicated team of surgeons to address all emergency department, inpatient, and transfer consultations, is quickly evolving within hospitals across the United States due to demonstrated improved patient outcomes in the non-trauma setting. The traditional model of call scheduling consisted of one senior attending and one senior resident on call per 24-hour shift. Attendings were responsible for consults, previously scheduled operations, as well as clinic time. Multiple recent studies have shown statistically significant improvements in several parameters of patient care by using ACS including but not limited to 1. Time from emergency department to surgical evaluation 2. Time from surgical evaluation to operating room 3. Operative time 4. Percent laparoscopic 5. Length of hospital stay 6. Intra-operative complications (blood loss, perforation rates) 7. Post-operative complications (fever, infection, redo) 8. Cost. One study demonstrated a statistically significant cost savings for the Acute Care Surgery model with respect to appendectomies, but not cholecystectomies.
Study Design: A retrospective analysis of patients who underwent cholecystectomy in the setting of non-traumatic emergent cholecystitis was performed to compare data from two cohorts: the traditional model and the ACS between January 1, 2013 and Dec 1, 2016 at Ochsner Medical Center, a 600-bed acute care center in New Orleans. Parameters gathered included 1. Time from emergency department to surgical evaluation 2. Time from surgical evaluation to operating room 3. Operative time 4. Percent laparoscopic 5. Length of hospital stay 6. Intra-operative complications (blood loss, perforation rates, conversion to open) 7. Post-operative complications (fever, infection, redo). Demographics were also collected including age, weight, height, ethnicity, ASA, etc. Inclusion criteria included: Age >18 and having undergone cholecystectomy between Jan 1, 2013 and December 1, 2016. Exclusion criteria included choledocholithiasis, gallstone pancreatitis, ascending cholangitis, gangrenous cholecystitis, septic complications precipitating further procedures and delays, or researcher discretion.
Results: 699 patients were initially identified as having undergone cholecystectomy within the allotted time period [2013 – 178, 2014 – 166, 2015 – 157, 2016 – 198]. 470 were excluded due to one of the reasons above. Median patient age was 53 years old and the average patient encounter was 3.9 days.
Conclusion: The ACS model is better suited to manage emergent non-traumatic cholecystectomies than the traditional call service at our institution, as evidenced by several parameters.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85509
Program Number: P059
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster