Time and cost analysis of gallbladder surgery under the acute care surgery model

J Trauma Acute Care Surg. 2014 Mar;76(3):710-4. doi: 10.1097/TA.0000000000000117.


Background: The acute care surgery (ACS) model has been shown to improve work flow efficiency and to reduce hospital stay. We hypothesized that, in patients with gallbladder (GB) disease who were admitted through our emergency department (ED) and then underwent surgery, the ACS model shortened the time to surgery, decreased the length of hospital stay, and reduced hospital costs.

Methods: We retrospectively queried our GB surgery practice records for 2008 (before the establishment of the ACS model at our institution in 2009). We then performed time and cost comparison with our prospectively maintained GB surgery practice database for 2010. We excluded any inpatient GB surgeries and any GB surgeries that were performed for choledocholithiasis and acute pancreatitis.

Results: Our study was composed of 94 patients from the pre-ACS period (2008) and 234 patients from the ACS period (2010). Patients' baseline characteristics were similar between the two periods, except for a higher percentage of females in the ACS period (77% vs. 66%, p = 0.04). Approximately one third of patients from both periods had acute cholecystitis. In the ACS period, the mean time to surgery, that is, from ED arrival to operating room arrival, was shorter (20.8 [13.8] hours vs. 25.7 [16.2] hours, p = 0.007); more patients underwent surgery within 24 hours after ED arrival (75% vs. 59%, p = 0.004); and more patients underwent surgery between 12:00 midnight and 7:00 AM (25% vs. 6.4%, p < 0.001). As a result, hospital length of stay was 1.4 days shorter in the ACS period, with cost saving per patient of approximately $1,000.

Conclusion: We found that implementation of ACS model led to benefits for patients who came to our ED with GB disease, including shorter time to surgery, shorter hospital stay, and decreased hospital costs. The ACS model benefits the health care system.

Level of evidence: Therapeutic study, level IV.

MeSH terms

  • Acute Disease
  • Adult
  • Cholecystitis, Acute / economics
  • Cholecystitis, Acute / surgery
  • Cost Savings / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Gallbladder / surgery*
  • Gallbladder Diseases / economics
  • Gallbladder Diseases / surgery
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Models, Organizational
  • Retrospective Studies
  • Time Factors