title: Management of acute mild gallstone pancreatitis under acute care surgery: should patients be admitted to the surgery or medicine service?
abstract: BACKGROUND
  We hypothesized that patients with acute mild gallstone pancreatitis (GSP) admitted to surgery (SUR; vs medicine [MED]) had a shorter time to surgery, shorter hospital length of stay (HLOS), and lower costs.
  
  
  METHODS
  We performed chart reviews of patients who underwent a cholecystectomy for acute mild GSP from October 1, 2009 to May 31, 2013. We excluded patients with moderate to severe and non-gallstone pancreatitis. We compared outcomes for time to surgery, HLOS, costs, and complications between the 2 groups.
  
  
  RESULTS
  Fifty acute mild GSP patients were admitted to MED and 52 to SUR. MED patients were older and had more comorbidity. SUR patients had a shorter time to surgery (44 vs 80 hours; P < .001), a shorter HLOS (3 vs 5 days; P < .001), and lower hospital costs ($11,492 ± 6,480 vs $16,183 ± 12,145; P = .03). In our subgroup analysis on patients with an American Society of Anesthesiologists score between 1 and 2, the subgroups were well matched; all outcomes still favored SUR patients.
  
  
  CONCLUSIONS
  Admitting acute mild GSP patients directly to SUR shortened the time to surgery, shortened HLOS, and lowered hospital costs.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA. Electronic address: nkulvatunyou@surgery.arizona.edu.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: John
authors.initials: J
authors.lastname: Watt
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Tang
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Arizona, Room 5411, 1501 North Campbell Avenue, PO Box 245603, Tucson, AZ 85727-5063, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D018806:APACHE; D000208:Acute Disease; D015992:Body Mass Index; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy / Q000379:methods; D015897:Comorbidity; D005260:Female; D042882:Gallstones / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: Gallstone pancreatitis; Medicine service; Surgery service