Impact of an acute surgical unit on outcomes in acute cholecystitis.

Abstract

The acute surgical unit (ASU) model has been associated with improved outcomes for emergency general surgical patients. Few Australasian studies have investigated patients with cholecystitis and none from South Australia. A retrospective cohort study compared patients admitted to our institution with acute cholecystitis during the 2 years before (traditional period) and after (ASU period) introduction of an ASU on 1 August 2012. Primary outcomes were length of stay, rates of definitive surgery on index admission, time to definitive surgery and proportion of cases performed in-hours. Secondary outcomes were time from emergency department referral to admission, time from radiologically confirmed diagnosis to theatre start, rates of conversion to open cholecystectomy, complications and cholelithiasis-related representations while awaiting definitive procedure. A total of 319 patients met the inclusion criteria; 172 and 147 pre- and post-ASU introduction, respectively. Compared with the traditional period, ASU patients had shorter length of stay (3.80 versus 2.83 days, P < 0.0001), higher rates of surgery on index admission (70.9% versus 95.3%, P < 0.0001), shorter time to definitive surgery (28.1 versus 22.1 days, P < 0.001), lower rates of conversion to open cholecystectomy (18.0% versus 7.1%, P = 0.007) and fewer complications (24.4% versus 6.1%, P < 0.0001). Other outcomes were not significantly different. Introduction of an ASU was associated with superior outcomes amongst patients admitted with acute cholecystitis. These findings extend the literature in support of the current model of care.