Acute Care Surgery (ACS) services have seen increasing traction. In our academic network two of three adult surgical hospitals utilize this arrangement. We sought to describe differences in cholecystitis management and outcomes between these care delivery models.

Fifty patients diagnosed with acute cholecystitis undergoing index admission cholecystectomy were selected from each hospital in reverse chronological order. Data from ACS services were pooled for analysis. Demographic, preoperative, operative, and postoperative data were collected. Primary endpoint was overall complication rate; secondary endpoints were length of stay (LOS) and time to
operating room (OR). Groups were compared using parametric and on parametric analysis. Linear regression was used to identify adjusted predictors of log-transformed LOS. 

Baseline characteristics were similar between patients at ACS and non-ACS hospitals. Time from arrival at emergency room to admission were comparable (ACS median 7 hours, non-ACS 7 hours; p = 0.61). Time from admission to OR was decreased at ACS hospitals (median 19.5 vs. 55.5 hours; p <0.01). Operative length (ACS 83 minutes, non-ACS 94 minutes; p = 0.47) and rate of conversion (4.0% vs. 10%;p = 0.16) were equivalent. Overall postoperative complication rates were similar between groups (ACS19%, non-ACS 30%; p = 0.19). On univariate analysis, median LOS was shorter among ACS than non-ACS hospitals (3 vs. 3.5 days, p <0.01). However, multivariable analysis demonstrated that LOS is affected
by presence of an ACS service (beta = 0.001, p = 0.98) but lengthened by other variables. Readmission rates did not differ between groups (2.0 vs. 8.0%; p = 0.10).

In conclusion, ACS services are effective in reducing time to operation in our academic network. Length of stay appears to primarily depend on other factors, however a trend favouring ACS is seen regarding perioperative complications and readmission rates, but no strong evidence at this time

Impact of Acute Care Surgery Service on Acute Cholecystitis Management and Outcomes at a Single Canadian Academic Network