Abstract: Background Fast track(FT) pathways have been adopted across a multitude of elective surgeries but have been slow to be adopted into the acute care surgery(ACS) realm. We hypothesized that a FT pathway for acute cholecystitis patients would decrease patient length of stay and resource utilization. Methods All patients at two hospitals, one with a FT pathway and one with a traditional pathway, that underwent an urgent laparoscopic cholecystectomy for acute cholecystitis between May 1, 2019 and October 31, 2019 were queried using CPT codes. Exclusion criteria were conversion to open or partial cholecystectomy. Retrospective chart review was used to gather demographics, operative, hospital course, and outcomes. Time to OR, hospital length of stay, and resource utilization were the primary outcomes. Results There was a total of 479 urgent laparoscopic cholecystectomies performed, four hundred and thirty(89.8%) were performed under the FT pathway. The median[IQR] time to the OR was not different: 14.1 hours[8.3-29.0 hours] for FT and 18.5 hours[11.9-25.9 hours] for traditional(p=0.316). However, the median length of stay was shorter by 15.9 hours in the FT cohort(22.6 hours, [14.2-40.4] vs 38.5 hours,[28.3-56.3];p0.2 for all). On multivariate analysis, having a fast track pathway was an independent predictor of discharge within 24 hours of surgical consultation(OR 7.65, 95% CI 2.90-20.15, p
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