Does the adoption of an emergency general surgery service model influence volume of cholecystectomies at a tertiary care center

INTRODUCTION

The purpose of this study was to evaluate the rate of cholecystectomy before and after adoption of an emergency general surgery (EGS) model at our institution.

METHODS

A longitudinal, observational study was conducted prior to and following introduction of an EGS model at our institution. Using the New York SPARCS Administrative Database, all adult patients presenting to the emergency department with gallbladder-related emergencies were identified. The rates of laparoscopic and open cholecystectomies performed 3 years prior and 3 years following the adoption of the EGS model were examined. A multivariable logistic regression model was used to compare the incidence of cholecystectomy at initial ED visit at our institution pre- and post-EGS introduction as well as to those in the rest of the state as an external control group, while adjusting for potentially confounding factors.

RESULTS

There were 176,159 total ED visits of patients with gallbladder emergencies (154,743 excluding repeat presenters) in the studied period in NY State. Of these, 63,912 patients (41.3%) had a concurrent cholecystectomy in NY State. The rate of cholecystectomy at these institutions remained relatively steady from 38.8% from 2010 to 2013 and 38.6% from 2013 to 2016. At our institution, there were 2039 gallbladder emergencies, and of those 755 underwent cholecystectomy. At our institution, there was an increase from 28.21% 3 years prior to the adoption of the EGS model to 40.2% in the following 3 years (RR = 1.06, 95% CI 1.0164-1.1078, p = 0.0069).

CONCLUSION

The initiation of the EGS model at a tertiary center was associated with a significant increase in the number of concurrent cholecystectomies from 28.21 to 40.2% over a 6-year period. This change was accompanied by an increase in the number of patient comorbidities and a lower insurance status.

An overarching approach for acute care delivery: extension of the acute care model to the entire inpatient admission

The acute care model has been proposed as a framework for quality improvement in emergency care to improve care delivery and patient flow. There is currently an absence of an overarching model inclusive of other relevant care settings, such as the inpatient ward or the intensive care unit (ICU), involved in the care of an acute illness episode. This gap limits our ability to optimize patient outcomes, improve flow, and reduce waste through all stages of acute illness. We propose that a unified approach to improve quality of care for acute illness may be achieved by extending the acute care model to the inpatient care setting.