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The Impact of Hospital Level of Care on the Management of Acute Cholecystitis: a Population-Based Study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Department of Surgery, Mora Hospital, Mora, Sweden.
Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
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2022 (English)In: Journal of Gastrointestinal Surgery, ISSN 1091-255X, E-ISSN 1873-4626, Vol. 26, p. 2551-2558Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital.

METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals.

RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075).

CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

Place, publisher, year, edition, pages
Springer, 2022. Vol. 26, p. 2551-2558
Keywords [en]
Acute cholecystitis, Hospital level of care, National registry, Surgery, Tertiary referral centers
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-200434DOI: 10.1007/s11605-022-05471-1ISI: 000869345400004PubMedID: 36253502Scopus ID: 2-s2.0-85140031379OAI: oai:DiVA.org:umu-200434DiVA, id: diva2:1704830
Available from: 2022-10-19 Created: 2022-10-19 Last updated: 2024-04-09Bibliographically approved

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Lindqvist, LisaHemmingsson, OskarNordin, PärEnochsson, Lars

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