title: Index cholecystectomy for management of acute gallstone disease: a change of practice at a major New Zealand metropolitan centre.
abstract: OBJECTIVE
  This study aimed to examine the effects of a change in practice in index cholecystectomy on waiting lists at a New Zealand metropolitan hospital.
  
  
  METHODS
  Patients presenting with gallstone disease from January 2004 to October 2010 were identified. Data on acute and elective cholecystectomies were collated and analysed for length of stay. Waiting lists for cholecystectomy were compared.
  
  
  RESULTS
  During the study period, 3999 patients were admitted with acute gallbladder disease. The median number of admissions decreased from 49 to 40 per month (P < 0.01). The median number of index cholecystectomies increased from three to 22 per month (P < 0.01). Total monthly bed days for all cholecystectomies decreased from 175 days to 124 days (P < 0.01), but only median postoperative bed days for acute cholecystectomy showed a similar trend, decreasing from 4 days to 3 days (P < 0.01). The number of patients on the waiting list decreased from 334 in January 2004 to 132 in January 2006 as a result of government-imposed cuts. The number of patients wait-listed for elective cholecystectomy remained unchanged.
  
  
  CONCLUSIONS
  An increasing number of index cholecystectomies have been performed at this centre. An effect on waiting list numbers is yet to be shown, but the wait list has not ballooned to previous numbers, although the number of patients joining the wait list remains unchanged. Monthly bed days have decreased for all patients with acute gallstone disease, probably in response to a combination of the changes implemented.
authors.affiliation: Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand. magda.sakowska@xtra.co.nz
authors.forename: Magdalena M
authors.initials: MM
authors.lastname: Sakowska
authors.forename: Saxon
authors.initials: S
authors.lastname: Connor
mesh_terms: D000208:Acute Disease; D002763:Cholecystectomy / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D009520:New Zealand; D010343:Patient Admission; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D019037:Urban Health Services / Q000706:statistics & numerical data; D014850:Waiting Lists