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The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis
Author(s) -
Pepingco Lester,
Eslick Guy D,
Cox Michael R
Publication year - 2012
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja11.11361
Subject(s) - medicine , acute cholecystitis , cholecystitis , retrospective cohort study , medical record , surgery , acute care , intensive care unit , adverse effect , general surgery , cholecystectomy , gallbladder , health care , economics , economic growth
Objective: To determine whether the introduction of an acute surgical unit (ASU) resulted in a greater proportion of patients with acute cholecystitis receiving definitive surgery on index admission with no adverse change in surgical outcomes. Design, setting and participants: A retrospective study of medical records for patients presenting to Nepean Hospital with acute cholecystitis during the 2 years before and 2 years after introduction of an ASU in November 2006. Main outcome measures: Time to diagnosis, timing of surgical intervention, surgical outcomes, duration of total admission and complication rates. Results: A total 271 patients were included in the study (114 pre‐ASU, 157 post‐ASU). After introduction of the ASU, a higher proportion of patients had surgery on index admission (89.8% v 55.3%; P < 0.001) and there were decreases in median time to diagnosis (14.9 h v 10.8 h; P = 0.008), median time to definitive procedure (5.6 days v 2.1 days; P < 0.001), median duration of total admission (4.9 days v 4.0 days; P = 0.002), rate of intraoperative conversion to open surgery (14.9% v 4.5%; P = 0.003) and rate of postoperative infection (3.5% v 2.5%; P = 0.40). Conclusion: Introduction of the ASU at Nepean Hospital resulted in significant improvements in care and outcomes for patients with acute cholecystitis.