title: Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed.
abstract: OBJECTIVE
  Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs. The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables, and to propose a therapeutic strategy that will allow us to improve the quality of care.
  
  
  METHODS
  We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered, and length of stay.
  
  
  RESULTS
  A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery Department, 257 (26%) to Internal Medicine-Digestive, and 18 (2%) to other departments. Four hundred ninety-eight (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 h at diagnosis), 152 (30%) at a late stage (>96 h at diagnosis), and 128 (26%) at a delayed date (other admission). Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non-operated ones (p<0.05). Patients<74 years old were more frequently operated than older ones (p<0.05).
  
  
  CONCLUSIONS
  The non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more readmissions, and high hospital costs. Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery Department, thereby increasing the probability of receiving definite treatment.
authors.affiliation: Department of General and Digestive Surgery, University Hospital of Salamanca-IBSAL, Paseo de San Vicente 58-182, 37007, Salamanca, Spain, cardiakez@yahoo.es.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: González-Muñoz
authors.forename: María
authors.initials: M
authors.lastname: Angoso
authors.forename: José María
authors.initials: JM
authors.lastname: Sayagués
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Sánchez-Casado
authors.forename: Alvaro
authors.initials: A
authors.lastname: Hernández
authors.forename: Antonio
authors.initials: A
authors.lastname: Velasco
authors.forename: Luís
authors.initials: L
authors.lastname: Muñoz-Bellvis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome