Maria S Altieri, MD, MS1, Suresh Yelika, MD2, Aurora Pryor, MD2, Jie Yang, PhD2, Lizhou Nie, MS2, Yiwei Fu, MS2, Mark Talamini, MD, MBA2, Samer Sbayi, MD2. 1Washington University School of Medicine, 2Stony Brook University Hospital
Introduction: The acute care surgery (ACS) model is a concept for provision of emergency general surgery, outside of trauma, which has been adopted among hospitals in the US over the past decade. The purpose of this study is to evaluate the effect of the adoption of the ACS model at our institution.
Methods: The ACS model at our institution started on Nov 1, 2013. Using the New York SPARCS Administrative Database, all adult patients presenting to the emergency department with acute cholecystitis with or without gallstones, biliary dyskinesia, and biliary colic were captured. The rates of laparoscopic and open cholecystectomies performed three years prior and following the adoption of the ACS model were examined. Variables included demographics, surgery related information, co-morbidities, and complications. Patients with missing data, duplicate records, age < 18 were excluded from the analysis. A multivariable logistic regression model was used to compare the incidence of cholecystectomy at initial ED visit at our institution to those in the rest of the state, while adjusting for other confounding factors.
Results: There were 176,159 ED visits in the studied period of 154,743 patients. 63,912 patients (41.3%) had a concurrent cholecystectomy. In our institution, there was an increase from 28.21% three years prior to the adoption of the ACS model to 40.2% in the following three years. The rates of cholecystectomy at the other institutions were relatively steady at 38.01% in 2010 and 39.32% in 2016. The rate of open cholecystectomy at our institution also decreased from 2.77% to 0.35% between 2010 and 2016, and this trend was also similar in the state of New York (2.91 % in 2010 to 0.1% in 2016. Patients operated during the adoption of the ACS model were older and had more co-morbidities. In addition, patients were more likely to be operated on for acute cholecystitis with or without obstruction (Table 1). There were no differences in terms of CBD injury between other state institutions and our institution (n=99, 0.16% vs n=1, 0.13%, p=1.0)
Conclusion: The initiation of the ACS model at a tertiary center helped increase the number of concurrent cholecystectomies from 28.21% to 40.2% in six years. Patients undergoing cholecystectomy were more likely to have acute cholecystitis, older, and with more co-morbidities.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95020
Program Number: S142
Presentation Session: Acute Care
Presentation Type: Podium