System Improvements for Both Elective and Emergency Cholecystectomy Patients after the Introduction of an Acute Surgical Unit

Abstract

Marang Makepe*, Yuchen Luo, Arthur Yim, Mark Tacey, David Leigh Bird and Russell Hodgson

Objective: Gallbladder pathology represents a significant proportion of general surgical workload. Pressures of theatre access, bed availability, and an elderly, co-morbid population may be alleviated by an Acute General Surgical Unit (ASU) model. The impact on elective cholecystectomy workload is unknown.

Methods: A retrospective audit was performed between February 2012 and February 2014 on 1289 patients undergoing emergency or elective cholecystectomy at a single institution, a year either side of an ASU introduction in February 2013.

Results: 642 patients that underwent cholecystectomy in the 12 months prior to ASU implementation were compared with 647 patient’s post-ASU. Demographic data was comparable in both groups. Comparing pre-ASU to post-ASU, in-hours cases increased (82.9% vs. 86.6%, p<0.001) with more consultant involvement (29.9% vs. 39.9%, p<0.001). Wait times improved for emergency cases (<2 days 42% vs. 58%, p=0.050). Interestingly, elective wait times also improved (<90 days 23% vs. 42%, p<0.001). Patients presented to emergency prior to cholecystectomy more frequently pre-ASU (31.6% vs. 27.2%, p=0.033). Post-ASU, higher acuity patients were seen, with an increase in suspected acute cholecystitis (25.5% vs. 34.8%, p<0.001), and more common bile duct stones were found (6.4% vs. 9.1%, p=0.064). There was no significant difference in morbidity post- ASU (13.4% vs. 18.4%, p=0.17).

Conclusion: The ASU model has contributed to improvements including theatre access, increased consultant involvement and also coincided with higher patient acuity. Interestingly, improved efficiency in emergency cholecystectomy has improved wait times for elective cholecystectomy.