Does an acute care surgical model improve the management and outcome of acute cholecystitis?

ANZ J Surg. 2010 Jun;80(6):438-42. doi: 10.1111/j.1445-2197.2010.05312.x.


The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home-call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on-site consultant. In addition, the ACS model provides greater consultant supervision to the trainee.

MeSH terms

  • Adult
  • Aged
  • Australia
  • Cholecystitis, Acute / surgery*
  • Female
  • General Surgery / organization & administration*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Models, Organizational
  • Patient Care Team / organization & administration*
  • Retrospective Studies
  • Time Factors