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

Abstract

Background: 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 non-elective cholecystectomies (CCY) across four different surgery practice models within a single hybrid urban hospital system.

Study design: Adult patients admitted through the emergency department who underwent CCY for acute biliary disease between 01/2018 to 12/2023 were categorized into four groups: ACS (ACS-MC), non-ACS faculty (FP-MC), private practice (PPP-MC), and community practice (PPP-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.

Results: Over 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 hours 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 LOS (2 days). 93.7% of ACS-MC cases were covered by a general surgery resident. PPP-CH had the lowest overall cost.

Conclusion: 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.