Improving Outcomes, Mythbusting

Surprise! Admitting to surgery for a surgical problem is better for everyone!

A chart review of patients who underwent a cholecystectomy for mild gallstone pancreatitis was performed on 50 patients with mild gallstone pancreatitis (As per Atlanta Classification) that were admitted to medicine and 52 that were admitted to surgery. Moderate to severe gallstone pancreatitis and non-gallstone pancreatitis were excluded. Medical admissions were more likely to be older and have more comorbidities. Surgical patients had a shorter time to surgery (44 vs 80 hours; P < .001), a shorter LOS (3 vs 5 days; P < .001), and significantly lower hospital costs. Subgroup analysis was performed on patients with an ASA score of one or two which matched well. All outcomes still favored surgical admission.

Sure, this is a chart review based on the patients who had a cholecystectomy, and does not include the number of patients that were solely medically managed, and does not include patients treated with ERCP without cholecystectomy. A Cochrane Review found that early ERCP for patients with biliary obstruction was associated with a non-significant trend towards reduction of local and systemic complications as defined by Atlanta Classification. Regardless, this should likely be a conversation between GI and general surgery, and not between GI, general surgery, and medicine.

I have recently wondered if there was any literature to support specialty findings (ie, gall stone pancreatitis, hip fractures) should go to a specialty service, rather than all findings going to medicine. In this particular case, there is a shorter time to surgery, shorter length of stay, and lower cost without an increase in patient morbidity or mortality. Would these findings cross over to orthopaedics for hip fractures? What about renal stones to urology? Syncope to cardiology?

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PMID: 25312841
http://pubs.rsna.org/doi/full/10.1148/radiol.11110947

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