The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis

Abstract

Objective: To determine whether the introduction of an acute surgical unit (ASU) resulted in a greater proportion of patients with acute cholecystitis receiving definitive surgery on index admission with no adverse change in surgical outcomes. Design, setting and participants: A retrospective study of medical records for patients presenting to Nepean Hospital with acute cholecystitis during the 2 years before and 2 years after introduction of an ASU in November 2006. Main outcome measures: Time to diagnosis, timing of surgical intervention, surgical outcomes, duration of total admission and complication rates. Results: A total 271 patients were included in the study (114 pre-ASU, 157 post-ASU). After introduction of the ASU, a higher proportion of patients had surgery on index admission (89.8% v 55.3%; P< 0.001) and there were decreases in median time to diagnosis (14.9 h v 10.8h; P= 0.008), median time to definitive procedure (5.6 days v 2.1 days; P< 0.001), median duration of total admission (4.9 days v 4.0 days; P = 0.002), rate of intraoperative conversion to open surgery (14.9% v 4.5%; P = 0.003) and rate of postoperative infection (3.5% v 2.5%; P= 0.40). Conclusion: Introduction of the ASU at Nepean Hospital resulted in significant improvements in care and outcomes for patients with acute cholecystitis.