Impact of acute care surgery on biliary disease

Background: We introduced an acute care surgery (ACS) service in July 2007 to address all new consults. This study examines the impact on treatment of biliary disease.

Study design: A retrospective review was done of a prospective database of all inpatient operative biliary disease treated in a tertiary care hospital 1 year before and 2 years after implementation of an ACS service. Data collected included diagnosis, time from admission to operation, time of operation, length of stay, comorbidities, and complications.

Results: There were 54 patients in the pre-ACS group and 132 in the post-ACS group, with no difference in percentage of females, comorbidities, and diagnosis. The post-ACS group had a trend toward a shorter time from consult to operating room (59.9 vs 68.7 hours, p = 0.45) and shorter hospital length of stay (5.5 vs 6.7 days, p = 0.27). In the acute cholecystitis post-ACS cohort, there was also a trend toward shorter time to operating room (39.8 vs 45.5 hours, p = 0.55) and shorter length of stay (4.6 vs 5.7 days, p = 0.39). The second year of ACS showed continued improvement in time to operating room (30.9 hours) compared with both pre-ACS and the first year of ACS. There was no significant difference in laparoscopic versus open surgery or complications between the groups.

Conclusions: There is a trend toward improvement in timeliness of care for complex inpatient biliary disease with implementation of an ACS service, especially as the service matures. There remains wide variability in patient complexity, which affects timeliness of care.