BACKGROUND This study was designed to compare the risks of morbidity and mortality of patients in a surgical department of an academic medical centre and a short-stay clinic. Furthermore, economic and patient-related parameters were assessed. METHODS A number of 50 respectively 33 consecutive patients scheduled for a cholecystectomy were included in this prospective study. Data were collected well-assorted against the POSSUM score, the duration of the operation, complications and the length of stay as well as quality of life and patient satisfaction. RESULTS No differences among patients of the two hospitals became apparent as they were referenced against the POSSUM score, nor were any discrepancies in expected respectively ex-post complications upon cholecystectomy observed. The continuance of the operative procedure was found to be significantly lengthened in the university hospital as compared with the non-academic clinic (120.1 +/- 34.3 min vs. 65.6 +/- 16.3 min; p < 0.001). The difference in durability splits up in 1.2 days pre-operatively versus 2.4 days post-operatively. In return, the post-operative pain therapy was esteemed much better in the university hospital. CONCLUSION The POSSUM score is a reliable tool to assess morbidity and mortality in surgical patients. The scores were found to be equal for patients in a university hospital and those in a short-stay clinic. Complications likewisely were equally low in both hospitals. The longer duration of the operation and the higher length of stay revealed structural benefits of the smaller unit. Advantages of the academic centre were found in the standards for pain therapy. The present study is taken both as a reference and as a basis for a fundamental process-redesign to the benefit of involved parties e. g. patients, relatives, staff in the university hospital.