title: Single center retrospective analysis of early vs. delayed treatment in acute calculous cholecystitis: application of a clinical pathway and an economic analysis.
abstract: BACKGROUND
  Treatment option and timing for surgery in case of acute calculous cholecystitis (ACC) is still a matter of discussion. Tokyo Guidelines (TG13) offers some rules but they don't reflect entirely the information of Evidence Based Medicine (EBM). This study aimed to draw some consideration from our practice in the application of the guidelines and put forward the clinical, economic and organizational effect of it.
  
  
  METHODS
  The study is a single center retrospective study based on administrative database formed by gathering information from clinical registry. Data were collected between January 1st, 2008 and April 30th, 2013. A cutoff point was established on May 15th, 2010 when we moved from a single surgeon method to a shared EBM method to treat ACC. The economic aspect was developed considering health service reimburse and hospital costs.
  
  
  RESULTS
  Five hundred and two patients were selected, 203 patients before the organizational change (Group 0) and 299 after (Group 1). In Group 0, 24.63% of the patients were treated with early laparoscopic cholecystectomy (ELC) and 39.4% received surgery delayed in second admission (DLC). After the change, 57.5% of the patients were treated with ELC while 13% were treated with DLC. Median length of stay (LOS) was significantly lower after the change (9.5 vs. 7.3, p<0.0001), and no difference in terms of complication was noticed.
  
  
  CONCLUSIONS
  Application of evidence based medicine in clinical practice resulted in better results. Economically, the clinical change resulted in a proper use of resources with a positive gap between the costs and refund to the hospital.
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pisano
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ceresoli
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Allegri
authors.affiliation: Department of Emergency, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Belotti
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Department of Emergency, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Colombi
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.affiliation: Department of Emergency, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Margarito
authors.affiliation: Department of Emergency, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Merli
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Montori
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Piazzalunga
authors.affiliation: Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000379:methods; D041881:Cholecystitis, Acute / Q000191:economics / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors