Surgeon Preference May Be More Important Than Models of Care When It Comes to Early Laparoscopic Cholecystectomy Rates for Acute Cholecystitis

Aim: Early Laparoscopic Cholecystectomy (ELC) for acute cholecystitis is widely accepted as the standard of care. The capacity to deliver this has been strongly linked to the establishment of Acute Surgical Units (ASU). This study aimed to determine the relative effects of surgeon preference on ELC rates. Method: A retrospective audit of patients with acute cholecystitis was carried out over 6 months in 3 hospitals in 2018. One hospital had an ASU and 2 hospitals had no ASU. The timing of cholecystectomy, intraoperative cholangiogram rates and length of hospital stay were collected. Results: 175 patients were included; 92 admitted to the ASU hospital and 83 admitted to non-ASU hospitals. When adjusted for severity, the ELC rate was 62% and 31% (P<0.0001) in the ASU hospital and non-ASU hospitals respectively in patients with mild (Tokyo Grade I) disease. There was no difference between intraoperative cholangiogram rates between hospitals. The initial length of stay was on average 2.4 days shorter in the early ELC patients (MD=-2.4, 95% CI 1.3 to 3.4). The 2 Non-ASU hospitals varied significantly in ELC rates (19% and 48% P=0.0158), the hospital with the higher ELC rates shared senior surgical staff with the ASU hospital. Conclusion: Hospitals with an ASU are better able to provide timely surgery to patients presenting with acute cholecystitis and this is associated with a reduction of time in hospital for these patients, but surgeon preference may be more important in determining ELC rates than the ASU model of care.