Direct admission to a surgical service reduces hospital length of stay for patients with biliary disease
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".