Impact of medical or surgical admission on outcomes of patients with acute calculous cholecystitis in a tertiary health care facility in the Philippines

Abstract

Introduction: Acute cholecystitis occurs most commonly because of an obstruction of the cystic duct by gallstones. This surgical disease warrants prompt cholecystectomy. Delays in the definitive surgical management result to more complications, longer hospital stays, and overall higher medical expenses. This study shows the disparity between the medical service and the surgical service in the management of acute calculous cholecystitis prior to its definitive intervention. Methods: Sixty-four patients (aged 18 to 74) presented to the emergency room, from January 2011 - December 2013, with acute calculous cholecystitis and underwent cholecystectomy during the same admission. Gallbladder disease severity, hospital length of stay, time to surgical evaluation, and time to cholecystectomy were compared between patients admitted to medical service and surgical service. Results: Thirty-three patients (51.6%) admitted under medicine service had more severe gallbladder disease found during cholecystectomy as compared to surgery service (Χ2 = 7.5147, p < 0.001). Patients admitted under surgery service had shorter hospital length of stay (4.06 days vs. 5.03 days, p = 0.059), waiting time to surgical consultation (3.14 hours vs. 16.10 hours, p < 0.001), and time to cholecystectomy (26.16 hours vs. 43.58 hours, p = 0.012). Conclusion: Patients presenting to the emergency room with acute calculous cholecystitis benefit from being admitted to a surgical rather than to a medical team irrespective of age and comorbidities.