Acute surgical unit safely reduces unnecessary after-hours cholecystectomy
The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care. A retro...
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| Veröffentlicht in: | Annals of the Royal College of Surgeons of England 2015-11, Vol.97 (8), p.568-573 |
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| creator | Suhardja, T S Bae, L Seah, E Z Cashin, P Croagh, D G |
| description | The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care.
A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm - 8am), length of stay and surgical complications.
A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p |
| doi_str_mv | 10.1308/rcsann.2015.0035 |
| format | Article |
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A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm - 8am), length of stay and surgical complications.
A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p<0.001) and the median length of stay (4 vs 3 days, p<0.001). The median operating time, rate of conversion to open cholecystectomy and wound infection rates remained similar.
Implementation of an ASU can lead to objective differences in outcomes for patients who present with acute cholecystitis. In our study, the ASU significantly reduced time to operation, the number of operations performed after hours and length of stay.</description><identifier>ISSN: 0035-8843</identifier><identifier>EISSN: 1478-7083</identifier><identifier>DOI: 10.1308/rcsann.2015.0035</identifier><identifier>PMID: 26492901</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adolescent ; Adult ; After-Hours Care - methods ; Age ; Aged ; Aged, 80 and over ; Appendicitis ; Cholecystectomy ; Cholecystectomy - statistics & numerical data ; Cholecystitis, Acute - surgery ; Cost control ; Demographics ; Emergency medical care ; Female ; Follow-Up Studies ; Gallbladder ; Gallbladder diseases ; Gallstones ; Hospital costs ; HPB surgery ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pancreatitis ; Patients ; Retrospective Studies ; Statistical analysis ; Surgeons ; Surgery ; Surgical outcomes ; Surgicenters - standards ; Unnecessary Procedures - trends ; Young Adult</subject><ispartof>Annals of the Royal College of Surgeons of England, 2015-11, Vol.97 (8), p.568-573</ispartof><rights>Copyright Royal College of Surgeons of England Nov 2015</rights><rights>Copyright © 2015, All rights reserved by the Royal College of Surgeons of England 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-974942b4bf46821483c857f8b06efe3508bc0d9871bf8aea17294cabcdd8e2403</citedby><cites>FETCH-LOGICAL-c424t-974942b4bf46821483c857f8b06efe3508bc0d9871bf8aea17294cabcdd8e2403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096602/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096602/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26492901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suhardja, T S</creatorcontrib><creatorcontrib>Bae, L</creatorcontrib><creatorcontrib>Seah, E Z</creatorcontrib><creatorcontrib>Cashin, P</creatorcontrib><creatorcontrib>Croagh, D G</creatorcontrib><title>Acute surgical unit safely reduces unnecessary after-hours cholecystectomy</title><title>Annals of the Royal College of Surgeons of England</title><addtitle>Ann R Coll Surg Engl</addtitle><description>The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care.
A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm - 8am), length of stay and surgical complications.
A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p<0.001) and the median length of stay (4 vs 3 days, p<0.001). The median operating time, rate of conversion to open cholecystectomy and wound infection rates remained similar.
Implementation of an ASU can lead to objective differences in outcomes for patients who present with acute cholecystitis. In our study, the ASU significantly reduced time to operation, the number of operations performed after hours and length of stay.</description><subject>Adolescent</subject><subject>Adult</subject><subject>After-Hours Care - methods</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Appendicitis</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy - statistics & numerical data</subject><subject>Cholecystitis, Acute - surgery</subject><subject>Cost control</subject><subject>Demographics</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gallbladder</subject><subject>Gallbladder diseases</subject><subject>Gallstones</subject><subject>Hospital costs</subject><subject>HPB surgery</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatitis</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Surgicenters - standards</subject><subject>Unnecessary Procedures - trends</subject><subject>Young Adult</subject><issn>0035-8843</issn><issn>1478-7083</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkc1Lw0AQxRdRbK3ePUnAi5fU2Y9kNxehFD8peNHzstlM2pQ0qbuJ0P_eDa2ingZm3ryZx4-QSwpTykHdOutN00wZ0GQKwJMjMqZCqliC4sdkPLRipQQfkTPv1wA0k4qekhFLRcYyoGPyMrN9h5Hv3bKypo76puoib0qsd5HDorfoQ6_BUL1xu8iUHbp41fbOR3bV1mh3vkPbtZvdOTkpTe3x4lAn5P3h_m3-FC9eH5_ns0VsBRNdnEmRCZaLvBSpYlQoblUiS5VDiiXyBFRuociUpHmpDBoqWSasyW1RKGQC-ITc7X23fb7BwmLTOVPrras24UPdmkr_nTTVSi_bT51AlqbAgsHNwcC1Hz36Tm8qb7GuTYNt73W4KAVPEzrcuv4nXYfoTYinGQMpVapABhXsVda13jssf56hoAdQeg9KD6D0QCWsXP0O8bPwTYZ_AawNkas</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Suhardja, T S</creator><creator>Bae, L</creator><creator>Seah, E Z</creator><creator>Cashin, P</creator><creator>Croagh, D G</creator><general>BMJ Publishing Group LTD</general><general>Royal College of Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>EHMNL</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20151101</creationdate><title>Acute surgical unit safely reduces unnecessary after-hours cholecystectomy</title><author>Suhardja, T S ; Bae, L ; Seah, E Z ; Cashin, P ; Croagh, D G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-974942b4bf46821483c857f8b06efe3508bc0d9871bf8aea17294cabcdd8e2403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>After-Hours Care - methods</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Appendicitis</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy - statistics & numerical data</topic><topic>Cholecystitis, Acute - surgery</topic><topic>Cost control</topic><topic>Demographics</topic><topic>Emergency medical care</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gallbladder</topic><topic>Gallbladder diseases</topic><topic>Gallstones</topic><topic>Hospital costs</topic><topic>HPB surgery</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreatitis</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Surgicenters - standards</topic><topic>Unnecessary Procedures - trends</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suhardja, T S</creatorcontrib><creatorcontrib>Bae, L</creatorcontrib><creatorcontrib>Seah, E Z</creatorcontrib><creatorcontrib>Cashin, P</creatorcontrib><creatorcontrib>Croagh, D G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>UK & Ireland Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Medical Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of the Royal College of Surgeons of England</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suhardja, T S</au><au>Bae, L</au><au>Seah, E Z</au><au>Cashin, P</au><au>Croagh, D G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute surgical unit safely reduces unnecessary after-hours cholecystectomy</atitle><jtitle>Annals of the Royal College of Surgeons of England</jtitle><addtitle>Ann R Coll Surg Engl</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>97</volume><issue>8</issue><spage>568</spage><epage>573</epage><pages>568-573</pages><issn>0035-8843</issn><eissn>1478-7083</eissn><abstract>The acute surgical model has been trialled in several institutions with mixed results. The aim of this study was to determine whether the acute surgical model provides better outcomes for patients with acute biliary presentation, compared with the traditional emergency surgery model of care.
A retrospective review was carried out of patients who were admitted for management of acute biliary presentation, before and after the establishment of an acute surgical unit (ASU). Outcomes measured were time to operation, operating time, after-hours operation (6pm - 8am), length of stay and surgical complications.
A total of 342 patients presented with acute biliary symptoms and were managed operatively. The median time to operation was significantly reduced in the ASU group (32.4 vs 25.4 hours, p=0.047), as were the proportion of operations performed after hours (19.5% vs 2.5%, p<0.001) and the median length of stay (4 vs 3 days, p<0.001). The median operating time, rate of conversion to open cholecystectomy and wound infection rates remained similar.
Implementation of an ASU can lead to objective differences in outcomes for patients who present with acute cholecystitis. In our study, the ASU significantly reduced time to operation, the number of operations performed after hours and length of stay.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>26492901</pmid><doi>10.1308/rcsann.2015.0035</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of the Royal College of Surgeons of England, 2015-11, Vol.97 (8), p.568-573 |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adolescent Adult After-Hours Care - methods Age Aged Aged, 80 and over Appendicitis Cholecystectomy Cholecystectomy - statistics & numerical data Cholecystitis, Acute - surgery Cost control Demographics Emergency medical care Female Follow-Up Studies Gallbladder Gallbladder diseases Gallstones Hospital costs HPB surgery Humans Laparoscopy Male Middle Aged Pancreatitis Patients Retrospective Studies Statistical analysis Surgeons Surgery Surgical outcomes Surgicenters - standards Unnecessary Procedures - trends Young Adult |
| title | Acute surgical unit safely reduces unnecessary after-hours cholecystectomy |
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