The addition of an acute care surgery service and its impact on appendicitis outcomes

Abstract

AbstractBackgroundThe introduction of the Acute Care Surgery (ACS) model has changed the culture of general surgery call. Without scheduled responsibilities, these surgeons can immediately see and intervene on emergency general surgery (EGS) patients. We hypothesise the constant and immediate availability of the ACS team along with a clinical scope focused on EGS patients results in improved outcomes in a common EGS pathology, appendicitis.MethodsFrom 2008 to 2018 a retrospective review was performed including all patients who underwent an appendectomy for acute appendicitis. Our institution established an ACS service in 2012. Patients were divided into two groups: the pre‐ACS and the post‐ACS groups. Primary endpoints included time intervals between diagnosis and surgery and overall length of stay (LOS) for both perforated and non‐perforated cases. The Fisher's exact test was used to analyse the data.ResultsThe pre‐ACS group had 85 patients and the post‐ACS group had 164 patients. When all patients were compared, the post‐ACS group has a significantly shorter LOS by 2.74 days (p < .001). The post‐ACS group also had a significantly shorter LOS for the non‐perforated (1.96 days; p = .05) and the perforated (5.08 days; p = .001) patients. There was nearly a 4‐h decrease (p = .05) in the time interval from diagnosis to operating room in the perforated post‐ACS group.ConclusionAppendicitis patients may receive more immediate care and require a shorter length of stay in institutions who support an ACS model. Further area of study could confirm benefits of an ACS service to other EGS pathologies.