title: Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis.
abstract: BACKGROUND
  Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS.
  
  
  METHODS
  The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed.
  
  
  RESULTS
  The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to 'surgeon preference/skill', was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs.
  
  
  CONCLUSIONS
  A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Bokhari
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: U
authors.initials: U
authors.lastname: Walsh
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: K
authors.initials: K
authors.lastname: Qurashi
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: L
authors.initials: L
authors.lastname: Liasis
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: J
authors.initials: J
authors.lastname: Watfah
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: M
authors.initials: M
authors.lastname: Sen
authors.affiliation: London North West Healthcare NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Gould
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D055815:Young Adult
keywords: Acute cholecystitis; Emergency surgery; Gallstones; Guidelines; Laparoscopic cholecystectomy