Primary admission to a surgical service facilitates early cholecystectomy in acute cholecystitis but does not influence patient outcome - Report - MDSpire
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Primary admission to a surgical service facilitates early cholecystectomy in acute cholecystitis but does not influence patient outcome
Initial Surgical Admission Promotes Timely Cholecystectomy in Acute Cholecystitis
Overview
This retrospective study of 512 patients with acute calculous cholecystitis (ACC) found that admission to the surgical service was associated with earlier cholecystectomy without negatively impacting patient outcomes. Patients admitted to the medical service had higher ASA scores but similar postoperative complication rates compared to those admitted to surgery.
Background
Acute calculous cholecystitis is a common emergency surgical condition often treated by early cholecystectomy within 72 hours to reduce complications and costs. In Germany, patients with ACC may be admitted to either medical or surgical services depending on hospital organization, which can influence timing of surgery. Previous data suggest medical admission may delay early cholecystectomy. This study aimed to evaluate perioperative management and outcomes based on admission service.
Data Highlights
Parameter
Medical Admission Group (MAG)
Surgical Admission Group (SAG)
p-value
Number of patients
Approx. 1/3 of 512
Approx. 2/3 of 512
–
Median age
66 years
66 years
Not significant
Female (%)
39.9%
47.6%
0.073
ASA III patients
Higher proportion
Lower proportion
Significant
ASA IV patients
3.3%
3.3%
Not significant
BMI
Comparable
Comparable
0.606
Weekday of admission
Comparable
Comparable
0.526
Oral anticoagulation use
14.0%
11.7%
Not significant
External referrals from hospital district
75.3%
81.1%
–
Key Findings
Patients admitted to the surgical service underwent earlier cholecystectomy compared to those admitted to medical service.
Medical admission group had higher ASA scores, indicating more comorbidities.
Despite differences in ASA scores, postoperative complication rates were similar between groups.
Both groups had comparable demographics including age, BMI, and gender distribution.
Use of oral anticoagulation and referral patterns were similar across groups.
Admission service did not affect perioperative length of stay or overall patient outcomes.
Clinical Implications
Early admission to the surgical service facilitates timely cholecystectomy in patients with acute calculous cholecystitis, potentially reducing delays without compromising safety. Hospitals should consider organizational strategies to prioritize surgical admission for ACC patients to optimize care pathways. Comorbidities should be carefully managed regardless of admission service to maintain favorable outcomes.
Conclusion
Admission to the surgical service promotes earlier cholecystectomy in ACC without adversely affecting patient outcomes, supporting early surgical involvement in management. Organizational factors influencing admission pathways should be addressed to improve timely care.
References
German Federal Statistical Office 2019 -- Number of cholecystectomies
ACDC-Trial 2013 -- Early cholecystectomy strategy
Tokyo Guidelines 2018 -- Severity grading and management of ACC
Previous study 2021 -- Medical admission decreases early cholecystectomy rates
