Abstract
BackgroundThe Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide.MethodsA literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles.ResultsThe search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care.ConclusionsLarge national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra- and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.
Highlights
Delivering adequate healthcare to the acutely ill surgical patient has been a challenge for decades
The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage, and 24/7 in-house resident coverage
Critical care is fully embedded in the original United States (US) model as part of the acute care chain (ACC), but is still a separate unit in most other countries
Summary
Delivering adequate healthcare to the acutely ill surgical patient has been a challenge for decades. In response to the lack of dedicated and well-organized services for the provision of non-traumatic emergency surgical care, the American Association for the Surgery of Trauma (AAST) initiated the development of the Acute Care Surgery (ACS) model, which was subsequently. World J Surg (2020) 44:2622–2637 adopted in most institutions offering emergency surgical care across the United States (US) [3]. Most high-income countries worldwide had a traditional on-call model, comprising of a rotating pool of surgeons managing most or all emergency surgical caseload in addition to elective duties [4]. No dedicated team was available, the surgeon on-call was often not on-site, and most emergency surgery was performed either in afterhours when an operating room (OR) was available, or elective cases were canceled in order to perform those interventions. Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. All relevant data of ACS models were extracted from included articles
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