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Patients with acute cholecystitis should be admitted to a surgical service
Ning Lu1, Joshuel A Pahang, Guangxiang Zhang
1From the Department of Surgery (N.L., L.L.W., W.L.B.) and Center for Outcomes Research and Evaluation (J.A.P., G.Z., A.L.), The Queen's Medical Center, and Department of Surgery, John H. Burns School of Medicine of the University of Hawaii (N.L., L.L.W., W.L.B.), Honolulu, Hawaii.
Background:
In bowel obstruction and biliary pancreatitis, patients receive more expedient surgical care when admitted to surgical compared with medical services. This has not been studied in acute cholecystitis.
Methods:
Retrospective analysis of clinical and cost data from July 2013 to September 2015 for patients with cholecystitis who underwent laparoscopic cholecystectomy in a tertiary care inpatient hospital. One hundred ninety lower-risk (Charlson-Deyo) patients were included. We assessed admitting service, length of stay (LOS), time from admission to surgery, time from surgery to discharge, number of imaging studies, and total cost.
Results:
Patients admitted to surgical (n = 106) versus medical (n = 84) service had shorter mean LOS (1.4 days vs. 2.6 days), shorter time from admission to surgery (0.4 days vs. 0.8 days), and shorter time from surgery to discharge (0.8 days vs. 1.1 days). Surgical service patients had fewer CT (38% vs. 56%) and magnetic resonance imaging (MRI) (5% vs. 16%) studies. Cholangiography (30% vs. 25%) and endoscopic retrograde cholangiopancreatography (ERCP) (3 vs. 8%) rates were similar. Surgical service patients had 39% lower median total costs (US $7787 vs. US $12572).
Conclusion:
Nonsurgical admissions of patients with cholecystitis are common, even among lower-risk patients. Routine admission to the surgical service should decrease LOS, resource utilization and costs.
Level Of Evidence:
Therapeutic/care management, level IV.
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