{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T11:34:13Z","timestamp":1743075253958},"reference-count":21,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T00:00:00Z","timestamp":1494892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Acute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (<jats:styled-content style=\"fixed-case\">ASU<\/jats:styled-content>) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional \u2018generalist\u2019 general surgery approach or the <jats:styled-content style=\"fixed-case\">ASU<\/jats:styled-content> model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A 6\u2010year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven hundred emergency laparoscopic cholecystectomies were performed over this time. A total of 486 patients were available for analysis. The median time to operation was 2\u2009days and median length of operation was 80\u2009min. A total of 86.9% were performed during daylight hours. Eight cases were converted to open surgery (1.6%). Intra\u2010operative cholangiography was performed in 408 patients. The major complication rate was 8.2%, including retained common bile duct stones (2.3%), sepsis (0.2%), post\u2010operative bleeding (0.4%), readmission (0.6%), bile leak (2.1%), <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content> (0.4%), unscheduled return to theatre (0.6%) and pneumonia (0.8%). There were no mortalities and no common bile duct injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Over a time period that encompasses the current publications on the <jats:styled-content style=\"fixed-case\">ASU<\/jats:styled-content> model, a subspecialty model of care has shown consistent results that exceed established benchmarks. Subspecialty management of complex elective pathologies has become the norm in general surgery and this study generates the hypothesis that subspecialty management of patients with complex emergency pathologies should be considered a valid alternative to <jats:styled-content style=\"fixed-case\">ASU<\/jats:styled-content>. Access block to emergency theatres delays treatment and prolongs hospital stay.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.13986","type":"journal-article","created":{"date-parts":[[2017,5,17]],"date-time":"2017-05-17T00:56:51Z","timestamp":1494982611000},"page":"560-564","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Subspecialty approach for the management of acute cholecystitis: an alternative to acute surgical unit model of care"],"prefix":"10.1111","volume":"87","author":[{"given":"Sonia","family":"Tran","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Choi","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten","family":"Hepburn","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Hewitt","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Zhou","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"},{"name":"UNSW Department of Surgery, St George Clinical School The University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel L.","family":"Chan","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"},{"name":"UNSW Department of Surgery, St George Clinical School The University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Talbot","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgery Unit St George Hospital  Sydney New South Wales Australia"},{"name":"UNSW Department of Surgery, St George Clinical School The University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,5,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-008-9576-y"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181d76bf6"},{"key":"e_1_2_6_4_1","unstructured":"GarlingP New South Wales Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals. Final report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals. Sydney: NSW Department of Premier and Cabinet 2008."},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.0480"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja11.11361"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2010.05312.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2447-1"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12473"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4458"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12022"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.13160"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-007-9444-1"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2005.00932.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1163-8"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1990.01410220029002"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318228d31c"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6870"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1998.00708.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199804000-00001"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-015-4325-4"},{"key":"e_1_2_6_22_1","first-page":"38","article-title":"Clinical variation procedure in profile: laparoscopic cholecystectomy","volume":"17","author":"Watters D","year":"2016","journal-title":"Surg. News"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fans.13986","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.13986","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T16:08:11Z","timestamp":1695485291000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.13986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,16]]},"references-count":21,"journal-issue":{"issue":"7-8","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1111\/ans.13986"],"URL":"https:\/\/doi.org\/10.1111\/ans.13986","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,16]]},"assertion":[{"value":"2016-11-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-05-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}