2010 Annual Meeting Abstracts
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Effect Of Weekend Admission On Management And Outcome Of Acute Cholecystitis
*Reza Kermani, *Peter HU Lee, *Haisar Dao-Campi, *Alan W Hackford, Marvin J Lopez, Sr.
St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, MA
Introduction: Acute cholecystitis may be managed by immediate surgical therapy or antibiotic therapy with interval cholecystectomy. We hypothesize that weekend admission makes surgeons more likely to pursue conservative management, resulting in greater delay to surgery, prolonged hospitalization, and increased costs.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for 2006 was performed. This is a cross-sectional administrative database that incorporates a 20% stratified sample of all US hospitals. ICD9 codes were used to identify diagnosis and procedures. All patients with non-elective admission for acute cholecystitis were included. T test was used to compare means of parametric variables and Chi square for non-parametric variables.
Results: 25,966 patients were identified. Weekend admission was associated with increased length of stay (4.3±4.1, p<0.001 vs. 4.1±3.9), increased delay to surgery (1.7±1.9 vs. 1.4±1.8 p<0.001), and increased hospital costs (30,223±28,469 vs. 29,197±28,784, p=0.013). There was no significant difference in the use of HIDA scans, use of ERCP, or decision to operate. There was no significant difference in likelihood to undergo or convert to open cholecystectomy in the two groups (12.3% vs 12.8%, p=0.23). Patients who were admitted on the weekend had a greater delay to surgery (2.1±2.1 vs. 1.8±2.1, p=0.005).
Conclusion: Patients admitted for acute cholecystitis on the weekend are more likely to have a greater delay to surgery, length of stay, and hospitalization costs. The decision to operate during the same hospitalization was not affected by admission on the weekend. Patients who are admitted with cholecystitis on the weekend are managed similarly to those who are admitted on the weekday though at a slightly slower pace and at increased cost.
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