Characteristics of patients undergoing cholecystectomy on acute care versus non-acute care services

Author(s):
Tynan Friend; Alexandra Halevi; Adam Aluisio; Daithi Heffernan; Brent Emigh; Tareq Kheirbek; Stephanie Lueckel; Charles A Adams; Benjamin Hall; Sean Monaghan; Andrew Stephen

Background:

Nationally, greater than 700,000 cholecystectomies are performed annually. The acute care surgery (ACS) model has shown benefits in costs and length of stay for management of gallbladder pathology but little has been described about characteristics of patients who are managed by ACS compared to non-ACS services.

Hypothesis:

.

Methods:

Retrospective review of laparoscopic cholecystectomy(CCY) at a tertiary center between March 2015 and January 2024. Weighted means of median age and income of patient zip code, along with categorical characteristics, were compared between those treated by ACS versus non-ACS services. Census data representing the 5 most common zip codes on each service were compared.

Results:

1,724 CCY were performed by ACS and 2,104 by non-ACS(Table 1). Patients treated by ACS were from zip codes with lower median income ($72,040 vs $82,617;p<0.001) and more often had Medicaid coverage(24.5% vs 12.2%;p<0.001) compared to those treated on non-ACS services. ACS patients were more often of Hispanic/Latinx origin (38.1% vs 17.3%;p<0.001), of non-white race(46.2% vs 23.0%;p<0.001), and were more likely to have a diagnosis of acute cholecystitis(49.7% vs 46.9%;p =0.003). 4 of the top 5 most common zip codes represented by patients on ACS services were within 3 miles of the hospital compared to 0 of the top 5 for patients on non-ACS services (Figure 1). Patients from the state’s five wealthiest zip codes were more often treated by non-ACS services(102 non-ACS vs 41 ACS;p<0.001), and the second and third poorest zip codes were among the 5 most frequent of those treated on ACS services.

Conclusions:

These differences highlight the role of ACS services in reducing healthcare disparities by directly improving care for those most underserved, while generating value for non-ACS services by facilitating practice expansion to areas with higher-reimbursing patients.