title: Does an acute care surgical model improve the management and outcome of acute cholecystitis?
abstract: The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home-call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on-site consultant. In addition, the ACS model provides greater consultant supervision to the trainee.
authors.affiliation: Department of General Surgery, Prince of Wales Hospital and University of New South Wales, Sydney, Australia. chrislehane@hotmail.com
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Lehane
authors.forename: Ravish N
authors.initials: RN
authors.lastname: Jootun
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett
authors.forename: Shing
authors.initials: S
authors.lastname: Wong
authors.forename: Phil
authors.initials: P
authors.lastname: Truskett
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors