SAGES 2026 Annual Meeting Emerging Technology Session

Acute Care Surgery vs. Standard Emergency Department Surgery: Comparison of Hospital Models for Management of Acute Biliary Pathology

Katia Noyes1, Ajay A Myneni2, Han Liu3, Geoffrey G Hobika1, Jeffrey Brewer1, Jeffrey Jordan1 Csaba Gajdos1, Schwaitzberg SD1, Kaitlin Ritter1

•Acute biliary conditions involving acute cholecystitis, choledocholithiasis, and cholelithiasis potentially require timely cholecystectomy as the definitive management.

•Surgical management in the emergency department (ED) for patients with these conditions may depend on surgeon and operating room availability.

•Hospitals may have a standard emergency department (SED) model with referrals to available private practice surgeons or an Acute Care Surgery (ACS) unit with 24/7 surgeon and OR availability.

•AIM: To assess access to surgery and outcomes in patients who presented with acute biliary conditions to hospitals with ACS vs. those with SED model of emergency care.

Data source: New York State (NYS) all-hospital, all-payer data (SPARCS), 2016─2019.

Selection of hospitals: Tertiary hospitals in Buffalo, NY, with ACS and SED models of care

Patient sample: Adult NYS residents who presented to ED with acute biliary pathology

Biliary pathology: Cholecystitis, Choledocholithiasis, Cholelithiasis

Matched sample analysis: Patients in ACS and SED groups were matched on age, sex, race, insurance and Charlson Comorbidity Index (CCI) to evaluate outcomes

•Patients with Cholecystitis visiting ACS vs. SED facilities had shorter length of stay and less likely to have percutaneous cholecystostomy at index visit.

•Patients presenting with Choledocholithiasis were more likely to undergo cholecystectomy at index visit at ACS vs. SED facilities

•Under- and over-utilization of surgical management at ACS vs. SED facilities require further investigation to improve treatment decision‑making.

SAGES 2026 Annual Meeting Emerging Technology Session

ACUTE CARE SURGERY VS. PRIVATE PRACTICE REFERRAL: COMPARISON OF HOSPITAL MODELS FOR MANAGEMENT OF ACUTE CHOLECYSTITIS.

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