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BACKGROUND:
Acute cholecystitis is one of the most common indications for emergency general surgery (EGS) in the US. We examined the role of acute care surgery (ACS) on interventions and outcomes for acute cholecystitis at a national sample of university-affiliated hospitals.
METHODS:
We surveyed senior surgeons responsible for EGS coverage at University HealthSystems Consortium (UHC) hospitals. The survey elicited data on resources allocated for EGS during 2013. Responses were linked to UHC outcomes data by unique hospital identifiers. Differences in interventions and outcomes between patients with acute cholecystitis treated at ACS hospitals vs. hospitals with a traditional on-call model were analyzed using univariate comparisons and multivariable logistic regression models.
RESULTS:
We found 3,131 patients with acute cholecystitis treated at 122 eligible hospitals. 48% had ACS (N =1705) while 52% had a traditional model (N=1426). ACS hospitals were more likely to treat minority and un/underinsured patients. (Table 1) They were more likely to treat patients with open cholecystectomy and cholecystostomy tubes and to have critically ill patients with higher ICU length of stay (LOS) than traditional models, but there were no differences in mortality, complications, or overall LOS. (Table 2) In multivariable models there were no differences in interventions or outcomes across hospitals.
CONCLUSIONS:
Hospitals with ACS models appear to be functioning as safety net options for both underserved patients and those with higher severity of gallbladder disease with seemingly equivalent outcomes compared to patients treated at hospitals with traditional on-call models.