A System Analysis of Early Cholecystectomy for Acute Cholecystitis

Objective: Debate continues on the timing of surgery for acute cholecystitis. Prompt cholecystectomy is most commonly performed. However, limited system resources may create delays. To map this process, we evaluated the timing and outcomes of patients undergoing cholecystectomy on an acute care surgery service. Methods: Seventy-five patients undergoing cholecystectomy for acute cholecystitis were enrolled and data collected and analyzed for patient flow, practice patterns, and performance improvement. Results: The mean hospital length of stay (LOS) was 104.3 hours (n=75). Patients undergoing cholecystectomy within 10 hours of diagnosis (EARLY) had a significantly shorter LOS compared to patients undergoing surgical intervention after 10 hours (LATE) (31.9 versus 110.1 hours, p \u3c 0.05). Fewer intra- and postoperative complications were observed in the EARLY group compared to the LATE group. Significant surgeon variation in time to operating room (OR) (mean 74 hours to 155 hours) was identified. The LOS was higher for patients with other comorbid conditions (ASA score 3-4). Mean LOS for patients converted to “open” was also significantly higher (191.4 hours) than others (78.8 hours) (p\u3c0.05). LOS and complications were independent of operating room (OR) duration, patient age and BMI, enzyme levels, payer source, and preoperative antibiotics. Conclusions: This study provided a map of the critical processes for preoperative interventions, timing of operation, and postoperative care. The gate function was OR availability, and delay to OR increased complications and LOS. This data will be shared with administration and better plan OR schedules for optimal use of hospital resources and improved patient outcomes