Abstract
BackgroundThe role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established.MethodsA retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared.ResultsTrauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% (P = .99) for all critically ill patients; and 13.9% vs. 27.4% (P = .12) for COVID-19 critically ill patients.ConclusionAcute care surgery is an “essential” service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services.Level of EvidenceIII.Study TypeTherapeutic.
Highlights
The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established
The number of trauma and emergency general surgery (EGS) patients decreased during this period, there was a dramatically higher number of critically ill patients treated by the ACS service during the surge period
When the contribution to the total number of patients treated by the Department of Surgery was calculated, the proportion of patients treated by the ACS service increased from 40% pre-COVID to 67% during the surge period
Summary
The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. The acute care surgery (ACS) is a relatively new surgical specialty that covers 3 clinical areas: trauma surgery, emergency general surgery (EGS), and surgical critical care (SCC). The main goals and organizational principles of the ACS model were initially outlined in the American Association for the Surgery of Trauma Ad Hoc Committee letter in 2005, which advocated for the creation of a new specialty that would provide comprehensive care to acutely ill surgical and trauma patients.[1] Trauma and EGS patients treated at specialized trauma and newly established ACS centers have achieved superior clinical outcomes compared to patients treated in nonspecialized centers.[2,3,4,5]. We hypothesize that the ACS model is applicable and effective in caring for both critically ill surgical and nonsurgical patients during a pandemic, like COVID-19, while still maintaining a provision of trauma and emergent surgical care
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