Timeliness of Care for Nonelective Cholecystectomy: Comparison of Surgical Practice Models

Acute care surgery (ACS) practice models with continuous on-site presence provide expedient and comprehensive care and serve as a critical safety net. The program benefits remain contested in comparison to other surgery practice models. We compared the efficiency of care for nonelective cholecystectomies (CCYs) across 4 different surgery practice models within a single hybrid urban hospital system.

Adult patients admitted through the emergency department who underwent CCY for acute biliary disease between January 2018 and December 2023 were categorized into 4 groups: ACS (ACS-main campus [MC]), non-ACS faculty (faculty physicians [FP]-MC), private practice (private practice physicians [PPP]-MC), and community practice (PPP-community hospital [CH]). The primary outcomes were the interval from admission to surgery and hospital length of stay. Secondary outcomes included surgery on a weekend, hospital costs, and readmission within 30 days. Comparison was performed with ANOVA.

During the 6-year study period, there were a total of 2,247 CCY: ACS-MC (43.3%), PPP-MC (28.3%), PPP-CH (19.4%), and FP-MC (9.0%). ACS-MC patients had the lowest time interval from admission to surgery (median 25.1 vs 61.1 hours for FP-MC, 33.2 hours for PPP-MC, and 30.3 hours for PPP-CH, p < 0.001). ACS-MC patients had the lowest median hospital length of stay (2 days), and 93.7% of ACS-MC cases were covered by a general surgery resident. PPP-CH had the lowest overall cost.

In an era of accelerated consolidation in healthcare markets, the results of this study may provide insight on how large healthcare systems may take advantage of the efficiency of the ACS model to ensure timely and quality care, at the lowest cost.