Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease

Abstract

Background: Biliary tract disease is a common condition often necessitating surgical intervention. It has been suggested that categorically admitting these patients to a surgical service rather than a medical service may improve patient outcomes. Our objective was to assess the impact of a protocol change that mandated preferentially admitting patients with biliary disease to a surgical service.

Methods: This is a retrospective observational study of patients presenting with biliary disease to a single institution before and after a protocol change that mandated admitting these patients directly to a surgical service. A generalized linear regression model was conducted to analyze the effect of practice change on length of stay, which was primary studied outcome.

Results: A total of 3,389 patients were included in the study (n = 1,866 for pre, and n=1,523 for post). There was no difference in hospital length of stay between pre and post groups for non-operative patients (1.9 days ± 4.3 versus 1.9 days ±5.2, p = .972).  However, for operative patients, length of stay was shorter for the post group (4.1 days ± 6.1 vs 6.3 days ± 14.0, p = .066). The linear regression model found that operative patients had an increased probability of having a longer length of stay (coefficient, 0.21; 95% CI, 0.14, 0.29; p < .001).

Conclusion: Admission of patients with biliary disease to a surgical service rather than a medical service is associated with shorter length of stay for patients who undergo an operative intervention. An approach of admitting all patients presenting with biliary disease to a surgical service has the potential to significantly reduce hospital costs. Our study supports primary responsibility for surgeons in the care of patients with potentially operative conditions.