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- W4306177737 abstract "Introduction: Index cholecystectomy (IC) is the gold standard for acute cholecystitis. Dedicated hospital-level practices for unplanned operations may impact the IC quality benchmark. Methods: Survey data on emergency general surgery (EGS) practices were linked with cholecystectomy data on patients ≥18 years of age admitted directly to 425 hospitals with acute cholecystitis. Univariate and multivariable regression analyses, clustered by treating hospital and adjusted for patient factors, were performed to estimate hospital-level risk-adjusted index cholecystectomy (IC) rates and cholecystectomy timing to examine operating room (OR) structure and process variables. Results: Of 14,710 patients admitted with acute cholecystitis, the risk-adjusted IC rate was 86%, with 8,484 (70%) completed in <1 day. Hospitals in the top quartile of risk-adjusted IC rate were more likely to have designated daytime OR time compared with other hospitals (32% v. 23%, p = 0.06) but this was not significant after adjustment. Hospitals in the top quartile for IC <1 day were more likely to have access to dedicated daytime ORs (33% vs 22%, p = 0.03). Compared with hospitals with minimal access to daytime OR time (<1 day/wk), hospitals with 1-4 days and ≥5 days of dedicated daytime OR time were more likely to achieve IC <1 day. (aOR 1.2, 95%CI 0.3-4.3 and aOR 2.5, 95%CI 1.3-5.0 respectively). Conclusion: Health systems should target an index cholecystectomy rate of 85% for acute cholecystitis with >70% of surgeries performed in <1 day. Access to daily OR time, as is often implemented with a dedicated acute care surgery model, may help achieve these quality metrics." @default.
- W4306177737 created "2022-10-14" @default.
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- W4306177737 date "2022-10-17" @default.
- W4306177737 modified "2023-10-17" @default.
- W4306177737 title "The Impact of Hospital-Level Resources on the Management of Acute Cholecystitis" @default.
- W4306177737 doi "https://doi.org/10.1097/01.xcs.0000895940.95883.c6" @default.
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