Time to Operating Room for Cholecystitis Decreases with a Mature Emergency General Surgery Service

Abstract

Emergency general surgery (EGS) services are designed to increase the availability of timely, high-quality care to patients with urgent surgical problems. One of the most commonly performed operations on such services is cholecystectomy. Improved outcomes have recently been described in early cholecystectomy for cholecystitis. We hypothesized that, as our EGS service matured, time from imaging to operating room (OR) for cholecystectomy would decrease. At an academic referral center, we identified patients undergoing inpatient cholecystectomy for acute cholecystitis during three time periods: before the formation of an EGS service from 2005 to 2007, during the first years of the service from 2008 to 2010, and five years after its development from 2013 to 2014. Charts were reviewed for patient demographics, operative events, and findings. The time of radiologic diagnosis and operation start time were recorded, and time between diagnosis and operation was calculated. A total of 217 patients who met the study criteria were identified, 88 in 2005 to 2007, 84 in 2008 to 2010, and 45 in 2013 to 2014. Time from radiologic diagnosis to OR decreased over the study period, from a median of 48.4 hours in 2005 to 2007 to 32.4 hours in 2008 to 2010 during the early years of the EGS service. Time to OR further decreased to a median of 16.6 hours during 2013 to 2014. The formation and maturation of an EGS service was associated with decreased time to OR after radiologic diagnosis of acute cholecystitis at this institution. This decrease in preoperative time may lead to lower costs and improved outcomes.