Impact of an acute surgical unit in appendicectomy outcomes: A systematic review and meta-analysis

Abstract

BackgroundThe provision of emergency general surgical services is undergoing a paradigm shift towards a consultant led, patient centered model in order to improve patient outcomes. The aim of this current study is to use meta-analytical techniques to assess the efficacy of acute surgical unit (ASU) in appendectomy. MethodsA meta-analysis was conducted according to the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus for published studies comparing ASU and traditional (TRAD) model on appendectomy outcomes was performed. Random-effects methods were used to analyze key outcomes with data presented as odds ratio (OR) with 95% confidence interval (CI). ResultsFourteen comparative studies describing outcomes in 7980 patients were identified, 4258 patients were included in the ASU model (53.4%). ASU model had a shorter time to theatre (WMD: −0.40, 95% CI: −0.65 to 0.15, p: 0.002), length of hospital stay (WMD: −0.25, 95% CI: −0.46 to −0.05, p: 0.02) and complication rate (OR: 0.76, 95% CI: 0.59 to 0.99, p: 0.04) for appendectomy patients. ASU model did not significantly affect night time operating (OR: 1.04, 95% CI: 0.66 to 1.65, p: 0.86) negative appendectomy rates (OR: 0.98, 95% CI: 0.77–1.27, p: 0.91) or conversion rate (OR: 1.45, 95% CI: 0.70 to 2.98, p: 0.32). ConclusionASU model improves outcomes and quality of care in patients undergoing emergency appendectomy without any adverse implications.