A. D. Kalani1, L. Gomez1, J. R. Popovich1, K. Lee1, S. Cassaro1,2 1Kaweah Delta Medical Center,General Surgery,Visalia, CA, USA 2University Of California – Irvine,Surgery,Orange, CA, USA
Introduction: Biliary pancreatitis (BP) is a frequent cause of emergency surgical admissions. In most cases BP is clinically mild and resolves rapidly. Current evidence indicates that a cholecystectomy should be carried out before discharge to avoid a frequent recurrence. The implementation of acute care surgery (ACS) services has been reported to positively affect adherence to cholecystectomy during the initial admission for BP, and to decrease average length of stay (ALOS). The presence of surgical residents has been reported to increase operative times. We report our experience with BP before and after the implementation of a dedicated ACS service at our institution to assess the impact of the service and the effects of a newly established Accreditation Council for Graduate Medical Education (ACGME) residency program in General Surgery.
Methods: We reviewed 420 BP admissions between January 1, 2010 and June 30, 2016 and abstracted demographics, ALOS, time from admission to surgery, time from surgery to discharge, and operative time, then compared them for periods before and after the creation of dedicated ACS service, as well as before and after the first class of surgery residents began its training.
Results: 373 (88%) patients were managed operatively and 47 (12%) non-operatively. A cholecystectomy was performed during the same admission in 352 (83%) patients. After the implementation of the ACS service, both overall and post-procedural ALOS decreased significantly (p<0.05) from 5.4 to 4.4 and from 3.4 to 2.1 days, respectively. There were no significant demographic or management differences between any of the periods reviewed.
Conclusion: Post-procedural ALOS decreased after the ACS started and operative time did not increase after a surgery residency was established.