Surgical outcomes of open cholecystectomy in the laparoscopic era.

Background: Although laparoscopic cholecystectomy has become the standard of care for symptomatic cholelithiasis and cholecystitis, 10% to 30% of cholecystectomies are still performed in open fashion. Because the total number of cholecystectomies is increasing with time, the average patient undergoing open cholecystectomy in the laparoscopic era is older and has more comorbidities.

Methods: The records of 1629 consecutive patients who underwent cholecystectomy from July 1997 to September 2006 were evaluated.

Effect of medical or surgical admission on outcome of patients with gallstone pancreatitis and common bile duct stones.

Introduction: Management of uncomplicated common bile duct stone (CBDS) and gallstone pancreatitis (GP) presumably varies based on whether a patient is admitted to medicine or surgery. This study evaluates the impact of admitting team on outcome and cost.

Methods: Three hundred seventy patients admitted to the Massachusetts General Hospital for CBDS or GP were retrospectively analyzed for demographics, insurance status, procedures, complications, length of stay, readmission, and cost.

Environmental impact of accelerated clinical care in a high-volume center.

Background: "Fast-track" surgery, involving multimodal care, improves efficiency and short-term outcomes in patients undergoing bowel resection. The sustainability of the benefits and the "drag" effect on non-participating surgeons through changed nursing and resident practice is undetermined.

Methods: 297 consecutive elective colon resections (DRG149) within three study periods (pre-change, immediate post-change, long-term post-change) were retrospectively reviewed.

Surgeon profiling: a key to optimum operating room use.

Hypothesis: A high-efficiency Pod, composed of 3 parallel-processing operating rooms (ORs) and a dedicated 3-bed miniature postanesthesia care unit, can be filled with surgeons capable of converting time saved from parallel processing into incremental volume.

Design: Statistical and mathematical modeling.

Setting: Academic medical center with 52 serial-processing ORs, 1 parallel-processing OR, and a congested postanesthesia care unit.

The effect of direct-from-recovery room discharge of laparoscopic cholecystectomy patients on recovery room workload.

Ambulatory laparoscopic cholecystectomy pathways move patients through the hospital without encountering delays caused by congested inpatient bed units. However, redirecting patients to a direct discharge pathway might not be beneficial if recovery capacity is further taxed by additional workload. In this study, we attempt to assess the operational impact on recovery room workload of directly discharging laparoscopic cholecystectomy patients to home.