{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:28:15Z","timestamp":1793017695000,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early laparoscopic cholecystectomy is recommended for acute cholecystitis, yet delivery is often constrained by emergency theatre access. We examined whether delay occurred mainly before or after the decision to operate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective single\u2010centre cohort of adults undergoing emergency laparoscopic cholecystectomy for coded acute cholecystitis at Cairns Hospital (July 2021\u2013June 2025). Primary outcomes were time to theatre, pathway decomposition, preoperative bed\u2010days and cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 122 patients, median preoperative wait was 2\u2009days (IQR: 1\u20133) and preoperative waiting accounted for 260\/482 bed\u2010days (53.9%). The decision to operate was made on the admission day in 102 patients (83.6%), yet 29 (28.4%) still underwent surgery after &gt;\u20092\u2009days. Across recorded pathway intervals, 148\/185\u2009days (80.0%) accrued between decision and operation. In the same\u2010day decision subgroup, waiting &gt;\u20092\u2009days was associated with similar postoperative length of stay (1 vs. 1\u2009day,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.496) and operative duration (108 vs. 112\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.285), but longer total stay (5 vs. 3\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Weekend admission was associated with lower odds of delay &gt;\u20092\u2009days (OR: 0.20, 95% CI: 0.07\u20130.54).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delay appeared to represent post\u2010booking inpatient queueing rather than delayed decision\u2010making or clinically useful optimisation. The findings suggest a policy\u2010capacity mismatch: early\u2010surgery standards have expanded in a setting of population growth without matching resource allocation to theatre, ward and staffing capacity, a problem likely relevant to many Australian public hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70819","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:43:51Z","timestamp":1782726231000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When Early Cholecystectomy Outpaces Capacity: Post\u2010Decision Delay, Population Growth and Six Service Solutions From a Regional Australian Cohort Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8278-6564","authenticated-orcid":false,"given":"Arnav","family":"Kalra","sequence":"first","affiliation":[{"name":"College of Medicine and Dentistry James Cook University  Cairns Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1600-7632","authenticated-orcid":false,"given":"Juyong","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cairns and Hinterland Hospital and Health Service Cairns Hospital  Cairns Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Beardsley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cairns and Hinterland Hospital and Health Service Cairns Hospital  Cairns Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0245-1272","authenticated-orcid":false,"given":"Esh","family":"Jeyarajan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cairns and Hinterland Hospital and Health Service Cairns Hospital  Cairns Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cairns and Hinterland Hospital and Health Service Cairns Hospital  Cairns Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"issue":"1","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13017-020-00336-x","article-title":"2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculus Cholecystitis","volume":"15","author":"Pisano M.","year":"2020","journal-title":"World Journal of Emergency Surgery"},{"issue":"1","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/jhbp.517","article-title":"Tokyo Guidelines 2018: Surgical Management of Acute Cholecystitis: Safe Steps in Laparoscopic Cholecystectomy for Acute Cholecystitis","volume":"25","author":"Wakabayashi G.","year":"2018","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"key":"e_1_2_9_4_1","article-title":"Early Versus Delayed Laparoscopic Cholecystectomy for People With Acute Cholecystitis","volume":"6","author":"Gurusamy K. 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N.","year":"2013","journal-title":"Annals of Surgery"},{"key":"e_1_2_9_8_1","unstructured":"Australian Institute of Health and Welfare \u201cPublic Hospitals and Beds \u201dCanberra: AIHW 2026 https:\/\/www.aihw.gov.au\/hospitals\/topics\/hospital\u2010resources\/public\u2010hospital\u2010beds."},{"key":"e_1_2_9_9_1","unstructured":"Australian Medical Association \u201c2026 Public Hospital Report Card \u201dCanberra: AMA 2026 https:\/\/www.ama.com.au\/articles\/2026\u2010public\u2010hospital\u2010report\u2010card."},{"key":"e_1_2_9_10_1","unstructured":"Australian Bureau of Statistics \u201cNational State and Territory Population September 2025 \u201dCanberra: ABS 2026 https:\/\/www.abs.gov.au\/statistics\/people\/population\/national\u2010state\u2010and\u2010territory\u2010population\/latest\u2010release."},{"key":"e_1_2_9_11_1","unstructured":"Queensland Health \u201cCairns Hospital Campus Master Plan \u201dBrisbane Queensland Government 2026 https:\/\/www.health.qld.gov.au\/system\u2010governance\/health\u2010infrastructure\/current\u2010activity\/cairns\u2010hospital\u2010campus\u2010master\u2010plan."},{"issue":"7624","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"335","author":"Elm E.","year":"2007","journal-title":"BMJ"},{"key":"e_1_2_9_13_1","unstructured":"Independent Health and Aged Care Pricing Authority \u201cNational Hospital Cost Data Collection Public Sector Report 2022\u201323 \u201dSydney: IHACPA 2025 https:\/\/www.ihacpa.gov.au\/sites\/default\/files\/2025\u201005\/nhcdc_public_sector_report_2022\u201023.pdf."},{"issue":"8","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1007\/s00464-018-6537-x","article-title":"Optimum Timing of Emergency Cholecystectomy for Acute Cholecystitis in England: Population\u2010Based Cohort Study","volume":"33","author":"Wiggins T.","year":"2019","journal-title":"Surgical Endoscopy"},{"issue":"23","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"7263","DOI":"10.3390\/jcm13237263","article-title":"Preoperative Waiting Time Affects the Length of Stay of Patients Treated via Laparoscopic Cholecystectomy in an Acute Care Surgical Setting","volume":"13","author":"Bressan L.","year":"2024","journal-title":"Journal of Clinical Medicine"},{"issue":"5","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.surge.2025.06.004","article-title":"The Effect of Timing of Emergency Cholecystectomy for Acute Cholecystitis on Peri\u2010Operative Outcomes: A National Registry\u2010Based Study","volume":"23","author":"Kehoe J. 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W.","year":"2013","journal-title":"World Journal of Surgery"},{"issue":"1","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/TA.0b013e3182788e4d","article-title":"A Population\u2010Based Analysis of the Clinical Course of 10,304 Patients With Acute Cholecystitis Discharged Without Cholecystectomy","volume":"74","author":"Mestral C.","year":"2013","journal-title":"Journal of Trauma and Acute Care Surgery"},{"key":"e_1_2_9_21_1","unstructured":"Safer Care Victoria \u201cInterval Cholecystectomy Following Acute Cholecystitis or Gall Stone Pancreatitis \u201dMelbourne: State Government of Victoria 2026 https:\/\/www.safercare.vic.gov.au\/best\u2010practice\u2010improvement\/clinical\u2010guidance\/non\u2010urgent\u2010elective\u2010surgery\/interval\u2010cholecystectomy\u2010following\u2010acute\u2010cholecystitis\u2010or\u2010gall\u2010stone\u2010pancreatitis."},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","DOI":"10.2196\/76807","article-title":"Cost\u2010Effectiveness of Day Surgery With Remote Patient Monitoring for Acute Cholecystitis: Economic Modeling Study","volume":"8","author":"Kuwornu J. 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