Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy

Abstract

Appendicectomy is a common general surgical emergency procedure and may be used as a surrogate marker to evaluate quality in surgical management. The aim of this study was to assess the outcomes of appendicectomy before and after the introduction of a consultant-led emergency general surgery (EGS) service at a large metropolitan tertiary referral centre. A retrospective historical control study was performed that included all adult patients undergoing appendicectomy during two 18-month periods, before and after the introduction of the EGS service. Data collected included patient demographics, use of radiological investigations, time to surgery, length of hospital stay and histopathology findings. Outcome measures were time to surgery, hospital length of stay, use of radiological investigations, negative appendicectomy rate and perforation rate. A total of 675 patients were identified of whom 276 had an appendicectomy before the EGS service was introduced (2008-2009) and 399 after its introduction (2011-2012). The EGS service resulted in an increase in time to surgery (15 versus 18 h; P < 0.001) with no increase in length of hospital stay (3 days for both periods; P = 0.424). An increase in the rate of appendicectomies performed within office hours was seen (54.3 versus 64.4 per cent; P < 0.001), with no significant increase in negative appendicectomy (13.0 versus 15.8 per cent; P = 0.322) or perforation (8.3 versus 5.5 per cent; P = 0.149) rates. The use of preoperative computed tomography reduced from 38.4 to 26.6 per cent (P = 0.001). The introduction of a consultant-led EGS service resulted in a decrease in the use of computed tomography and a greater proportion of appendicectomies performed within office hours, with no increase in length of stay. Overall negative appendicectomy and perforation rates did not change.