General Surgery Service Research Articles

Interruptions experienced by nurses during preparation and administration of medications at the patient’s bedside/corridor: Duration and causes, Turkey

Background: Nurses experience many interruptions during drug administration. Interruptions threaten the safety of patients and nurses in health institutions.Aim: This study aimed to investigate the interruptions experienced by nurses during preparation and administration of medications at the patient’s bedside/corridor in different clinics.Methods: Interruptions was determined by several observations. Observations carried out during nurses’ medication process in internal medicine and surgical services (by two researchers). Sixty observation were made in total by two researchers.Results: Interruptions were detected at least once in the preparations and administration process in all of the observations. The interruption frequency in preparation, administration and the whole process were statistically significant different between the services. The interruptions in the general surgery service were higher than the internal medicine service. The interruption frequency was significantly higher during the preparation process in internal medicine service and administration process in general surgery service.Conclusions: Interruptions during nurses’ medication process at the patient’s bedside or in the corridor was commonly observed, especially in the general surgery service.

A Tale of Two Campuses? An Analysis of Two Affiliated Medical School Campuses With Different Match Rates in General Surgery

The purpose of this study was to compare factors that contribute to increased match rates into general surgery. Survey study. University of Kansas School of Medicine Campuses. A survey assessing experiences and perceptions during their surgical clerkship was sent to graduating medical students from a single university with a hybrid (academic-affiliated community-based) campus, and an academic campus. Specific questions were asked with regard to residents and attendings, procedural experiences, perceived lifestyle, and general interest in surgery before and after clerkship. The match rate into general surgery was significantly higher on the hybrid campus (14.7% vs 4.0%, p = 0.215). Factors that were positively correlated with interest in surgery included interactions with attendings (0.86) and residents (0.63), time spent in the OR (0.77), participation in the OR (0.62), and complexity of cases (0.61). Students on the hybrid campus spent more weeks on general surgery services (6 vs 4, p < 0.001). More students from the hybrid campus were "Not interested at all" in surgery prior to their surgery clerkship (26.5% vs 16.0). Significantly more academic students indicated they were "Not interested at all" in surgery after their surgery clerkship (52.0 vs 17.6%), while more students on the hybrid campus indicated they were "extremely interested" (29.4 vs 12.0%, p = 0.005) after their surgery clerkship. The rate of students matching into general surgery between the 2 campuses are different, with the hybrid campus having nearly 4 times the rate of students matching into general surgery. Programs may be able to increase their match rate by allowing students more opportunities to participate in the operating room, spending more time on a general surgery service, and by ensuring that medical students are included as members of the surgical team.

ACERTO PROJECT: IMPACT ON ASSISTANCE OF A PUBLIC EMERGENCY HOSPITAL.

ABSTRACT Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.

An unexpected result of playing football: Anal laceration

Severe anal region injuries are rarely seen in emergency departments, but these injuries may be associated with morbidity and mortality. This case report aims to present a patient whose anal region was injured in a sports accident. An 18-year-old male patient was admitted to the emergency room because of a knee blow to his anal region while playing football. In the anamnesis of the patient was determined pain and laceration in the anal region. The patient had no additional complaints. On physical examination of the patient; approximately 2-3 cm of laceration was observed around the patient’s anal region, extending from the anal mucosa at the 7 o’clock direction. The patient was operated by a general surgeon and discharged after 1 day of hospitalization at the general surgery service. It should not be forgotten that there may be anal region traumas during football matches, one of the common sports. People should be careful to protect themselves from physical blows that can occur when playing football.

Awareness on prostate cancer and screening practices among men attending outpatient at a referral hospital in Kigali, Rwanda: A quantitative study

BackgroundProstate cancer is estimated to be the second of all under diagnosed cancer and it is ranged the sixth among the cause of cancer mortality worldwide. The sensitization related to prostate cancer awareness and its screening needs to be encouraged among adult men to avoid late consultation and reduce prostate cancer morbidity and mortality. Purpose of the studyTo assess prostate cancer awareness and screening practices among adult males attending outpatient department at Kigali university teaching hospital, Rwanda. MethodologyA quantitative, descriptive cross-sectional design was used in this study. A systematic random sampling technique was used to select 257 adult males, who participated in the study. Participants were chosen from among the men who consulted urology and general surgery services at University Teaching hospital of Kigali (CHUK) Rwanda, during 8 weeks of the study period. ResultsAmong 257 participants in the study, the great proportion (43%) of respondents ranged between 51 and 60. 80% of the respondents were aware of prostate cancer existence and reported the health provider as being the major source of the information. Knowledge on various domains was low and 64% of the respondents were not aware of the risk factors of prostate cancer, 32% did not know the prevention measures of prostate cancer, 64% of the respondents were aware of prostate cancer screening using PSA exam and 49% of the respondents had undergone screening by performing PSA exam. Overall prostate cancer awareness and screening practice was 75% and 49.5% respectively. Having a university level education was significantly associated with P Ca awareness and screening practices (p < 0.004), and working in public institutions had a strong correlation to Prostate cancer awareness and screening practice (p < 0.000). ConclusionThe level of awareness of prostate cancer was high while knowledge on some areas was low. Screening practices were found to be poor, almost half of participants did not perform PSA test. There is a need to improve health education to the community regarding prostate cancer to enhance knowledge and increase the rate of screening.

Cerrahi Alan İnfeksiyonlarının Değerlendirilmesi ve Risk Faktörlerinin Analizi

Surgical site infections (SSI) extend the patient’s length of stay, causing unnecessary complications and increase mortality, morbidity and cost. In each hospital, these infections take place in hospital infection surveillance and show changes specific to hospitals. In this study, the files of 402 patients; hospitalized between 2016 and 2018 in the surgical clinics of the Health Sciences University Bursa High Specialization Training and Research Hospital were analyzed retrospectively in terms of SSI, patient profile, length of stay, underlying diseases, risk factors and causative microorganisms. In the study, patients in gynecology and obstetrics, pediatric surgery, cardiovascular surgery, orthopedics, general surgery, urology, and neurosurgery services were included in the surgeries that were followed up on the basis of the procedures in accordance with the decisions of the infection control committee. The most frequently isolated microorganisms in SSI were coagulase negative staphylococci (14.7 %) Escherichia coli (11.7 %), Staphylococcus aureus (6 %) Klebsiella spp. (7 %) and Pseudomonas spp. (3.5 %), while the rate of culture negative SSI cases was determined as (41.5 %). In statistical analysis; presence of a foreign body prosthesis, coronary artery disease, diabetes mellitus, hypertension, hemodialysis, H2 receptor antagonist use, chest tube, peripheral artery catheter, central venous catheter, nasogastric catheter, surgical drain, transfusion, urinary catheter, peripheral venous catheter, mechanical ventilation and endotracheal intubation were statistically significant in the development of SSI. In the analyzes on length of stay, it was found that the length of stay significantly increased as the depth increased in the SSI classification. Identifying risk factors for SSI is critical to reduce the incidence of SSI and identify high-risk patient populations that may require more surveillance for postoperative infection and to develop quality improvement strategies and infection control interventions.

Spectrum of Acute Non Traumatic Diffuse Secondary Peritonitis in the Tropics

Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment of typhoid fever and amoebiasis can reduce the incidence of peritonitis. Early consultation together with adequate resuscitation and surgical management can improve the prognostic which still remains poor.

Abdominal wall endometriosis: experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense.

to study the characteristics of women undergoing abdominal surgery with suspected abdominal wall endometriosis or abdominal wall tumor, and to assess the association with age, race and previous cesarean delivery. retrospective and analytical study carried out from January 2000 to December 2019, at the General Surgery Service of Hospital Universitário Antônio Pedro (HUAP) at Universidade Federal Fluminense (UFF). Medical records of 100 patients with abdominal wall endometriosis and other types of abdominal wall tumors were analyzed. Age, color, previous history of cesarean section or abdominal surgery and histopathological data were verified. The patients were classified as young adults (aged between 18 and 28 years and 11 months) and adults. The SPSS program was used for data analysis, Fisher's test with a significance level of 0.05. abdominal wall endometriosis with histopathological confirmation was found in 22%, the mean age was 52.28 ± 18.66 which was lower when compared to other diagnoses. There was an association between previous cesarean section and abdominal wall endometriosis (p <0.005). the women with a diagnosis of abdominal wall endometriosis had undergone previous cesareans (the majority) and were in an active reproductive age. Although the brown skin women were the most frequent, there was no statistical difference.

Duration of Hospital Stay and Treatment Pattern among Patients Undergoing Common Operative Procedures at tertiary care hospital in Nepal

Background and Objectives: Appendectomy, cholecystectomy, fistulectomy, and herniotomy or herniorrhaphy are the most common surgical operations in Nepal. Despite the high prevalence and complexity of the patient population served by general and universal surgery services, little has been reported about the services, treatment procedures and outcomes. Therefore, the study is designed to investigate the duration of hospital stay, and treatment pattern among patients undergoing common surgical operative procedures at Janaki Medical College, Janakpur, Nepal. &#x0D; Material and methods: A prospective observational study was conducted among patients undergoing common surgical operative procedures at surgery department of Janaki Medical College (JMC) over a period of one year from January 2018 to December 2018. Patients of all age groups and gender undergoing surgical operative procedures; appendectomy, herniotomy cholecystectomy and fistulectomy were included in the study. The patients were assessed preoperatively, intra-operatively and postoperatively. &#x0D; Results: In a total of 325 patients, 11.1% of patients underwent fistulectomy, 14.5% underwent appendectomy, 35.4% underwent herniorrhaphy and 39.1% underwent cholecystectomy. Mean duration of stay at hospital for cholecystectomy was slightly higher (8.13±2.40 days) than other operating procedures: fistulectomy (5.44 ±1.48 days), appendectomy (7.40±2.00 days), and operative procedure of hernia (6.17±1.59 days). Most commonly used antibiotic for control of preoperative and post operative infection was third generation cephalosporin’s, ceftriaxone and cefixime. &#x0D; Conclusion: The study demonstrates longer duration of hospital stay for cholecystectomy as compared to other operating procedures like fistulectomy, appendectomy, herniorrhaphy, hernioplasty and herniotomy with significant difference by types of surgery. Most commonly used antibiotic for control of infection was third generation cephalosporin, ceftriaxone and cefixime.

Severity of Postoperative Complications From the Perspective of the Patient.

Background:Although provider-derived surgical complication severity grading systems exist, little is known about the patient perspective.Objective:To assess patient-rated complication severity and determine concordance with existing grading systems.Methods:A survey asked general surgery patients to rate the severity of 21 hypothetical postoperative events representing grades 1 to 5 complications from the Accordion Severity Grading System. Concordance with the Accordion scale was examined. Separately, descriptive ratings of 18 brief postoperative events were ranked.Results:One hundred sixty-eight patients returned a mailed survey following their discharge from a general surgery service. Patients rated grade 4 complications highest. Grade 1 complications were rated similarly to grade 5 and higher than grades 2 and 3 (P ≤ .01). Patients rated one event not considered an Accordion scale complication higher than all but grade 4 complications (P < .001). The brief events also did not follow the Accordion scale, other than the grade 6 complication ranking highest.Conclusion:Patient-rated complication severity is discordant with provider-derived grading systems, suggesting the need to explore important differences between patient and provider perspectives.

3038 A Rare Case of Pancreatitis Due to Paraesophageal Hernia

INTRODUCTION: Pancreratitis due toWe present a rare case of acute pancreatitis due to a large paraesophageal hernia who presented to the emergency department with chief compliant of epigastric pain and dysphagia. CASE DESCRIPTION/METHODS: A 65-year- old female presented to our emergency department due to progressively worsening epigastric pain. The pain sharp, intermittent and moderate in severity and radiated to her back associated with nausea and vomiting. She denied fever, shortness of breath, or chest pain. A review of systems was otherwise negative. Physical examination including vital signs was unremarkable with the exception of mild epigastric tenderness on palpation. Seven years prior to admission, patient underwent laparoscopic cholecystectomy for gallstones pancreatitis. Laboratory data was unremarkable. Although her serum lipase was within normal limits (114 U/L), her history and physical were concerning for pancreatic pathology. Therefore, CT scan of the abdomen was obtained and demonstrated trace inflammatory fluid around the pancreatic uncinate process, consistent with mild pancreatitis. Additionally, a massive hiatal hernia was noted causing mild atelectasis in the lung bases. The patient was admitted to our facility and was treated for the presumptive diagnosis of recurrent pancreatitis. Of interest, five months prior to this admission, the patient had presented to the ED with similar symptoms. CT imaging at that time had also demonstrated large paraesophageal hernia. She was evaluated by our general surgery service and was deemed not to be a candidate for surgical intervention. Due to the recurrent nature of her symptoms, she subsequently underwent esophagogastroduodenoscopy during which the paraesophageal hernia was identified with a large amount of food and fluid within it. Thusly she was reevaluated by our general surgery team and ultimately underwent reduction of her stomach, paraesophageal hernia repair, and gastrostomy tube insertion. Patient did well post-operatively with no complication. Patient was discharged to rehab 7 days after surgery. DISCUSSION: We believe that the patient's recurrent symptoms were the result of progressive enlargement of the paraesophageal hernia that manifested as a gastric volvulus. There are few cases of pancreatitis due to paraesophageal hernia leading pancreatic herniation1. Serum lipase measurements that are below normal limits can indicate chronic pancreatitis2. Few cases of pancreatitis were reported with low lipase.2

1258 A Case of Direct Necrosectomy via Sinus Tract Endoscopy in the Retroperitoneum: A Unique Approach to a Difficult Problem

INTRODUCTION: Pancreatic fluid collections are one of the most common complications of acute pancreatitis. While the majority of pancreatic fluid collections are self-limited, acute necrotic collections have a high likelihood of evolving into walled off pancreatic necrosis, with nearly two-thirds of cases requiring intervention. Endoscopic debridement of centrally located walled off pancreatic necrosis via transmural stents and direct necrosectomy is becoming increasingly popular due to its high success rate and low associated morbidity and mortality. Management of lateral walled off pancreatic necrosis has traditionally been managed surgically. New innovations in multidisciplinary, minimally invasive procedures are becoming increasingly utilized, though case reports are rare. We present a case of sinus tract endoscopy via a surgically placed trocar to debride an extensive collection of walled off necrosis in the left retroperitoneal space. CASE DESCRIPTION/METHODS: Our patient is a 65-year-old female with a history of alcohol induced, necrotizing pancreatitis with infected walled off necrotic collections extending along the infrarenal spaces bilaterally. She initially underwent computed tomography guided percutaneous catheter placement, which failed to provide source control. Given the large size and technically difficult location of the infrarenal necrosis, a multidisciplinary approach was pursued. In the operating room, the general surgery service placed a 15 mm surgical trocar into the left retroperitoneal space to successfully access the lesion. The therapeutic gastroenterology team then advanced a pediatric colonoscope via the trocar into the retroperitoneal space. Following the previously placed percutaneous drains, and utilizing various sized snares, 3-prong grasper, and Rat tooth forceps, all necrotic tissue was successfully debrided and retrieved. A wire was left in place and used to successfully place a surgical drain. The patient tolerated the procedure well without acute complications. Repeat cross sectional imaging demonstrated significant interval decrease in size of the necrotic collections. The patient recovered without further intervention and was doing well at 6 month follow up. DISCUSSION: Sinus tract endoscopy via surgically or CT guided placement of trocars is an efficacious and safe procedure for lateral walled off pancreatic necrosis. Our case illustrates the evolving role for minimally invasive procedures for pancreatic fluid collections inaccessible to transmural approaches.

Toward Autonomy and Conditional Independence: A Standardized Script Improves Patient Acceptance of Surgical Trainee Roles

Background Progressive autonomy leading to conditional independence is necessary to achieve competence in surgical skills and decision making. Trust and transparency are ethical imperatives, but practices vary regarding the extent of disclosure of specific resident roles. We tested whether a standardized preoperative script would improve patient acceptance of resident involvement in perioperative care. Methods Patients admitted to a resident-run acute care general surgery service between October 2017 and October 2018 were enrolled in an IRB-approved study. During the first half of the rotation (control), operative consent was obtained according to individual practice without specified explanation of resident roles. During the second half (intervention), the senior resident read a short semistructured script specifically explaining team roles and responsibilities, including the degree of resident independence and supervision by attendings. On postoperative day 3, patients completed a survey assessing understanding of surgical care. Results Sixty-two patients under the care of 10 rotating chief residents were enrolled; 46 patients completed the survey, 23 in each arm (74% response rate). Ten patients in the control arm (43%) compared to only 3 (13%) in the intervention arm indicated that residents should not be allowed to perform portions of operations (odds ratio 4.94, p = 0.047). Patients in the intervention arm felt that care team roles were more adequately explained to them before operation (p = 0.002). There was no difference in the number of patients naming a resident as their doctor. Conclusions Use of a short script specifying resident roles improves patient acceptance of trainee participation in perioperative care.

Spontaneous Pneumopericardium in a U.S. Marine: Do not Lose Heart.

We report an unusual case of extensive subcutaneous emphysema, pneumomediastinum, and pneumopericardium identified in an otherwise healthy U.S. Marine who was enrolled in the Marine Corps School of Infantry. His training regimen included prolonged periods of yelling and elevation changes during sustained hiking through hilly terrain. The patient presented to the Fast Track with normal vital signs but complained of dyspnea, cough, and subjective fevers. Although he lacked a history of trauma, he was found to have pneumopericardium, pneumomediastinum, and subcutaneous emphysema without pneumothorax. He was admitted to the general surgery service for observation and was ultimately released back to his unit after 24hours. To our knowledge, pneumopericardium has never been attributed to persistent yelling in the setting of a lower respiratory tract infection and should be considered in the differential of atraumatic chest symptomatology in otherwise healthy military service members.

Caracterización del trauma craneoencefálico

Se denomina recurrencia al desarrollo de una nueva hernia independientemente del sitio anatómico, con la única condición de que sea del mismo lado operado previamente. El estudio realizado fue de tipo descriptivo retrospectivo, con el propósito de determinar la recurrencia de las hernias inguinales de acuerdo a las técnicas de reparación quirúrgica en los pacientes postoperados en el Servicio de Cirugía General de adultos del Hospital Regional de Zacapa entre enero de 2013 a diciembre de 2017. La información obtenida fue por medio de la ficha recolección datos, que ayudó a determinar una alta prevalencia de recurrencia de hernia inguinal con un 7% (10) de 137 casos que fueron intervenidos por hernia inguinal, con un predominio en el sexo masculino con un 90% (9), la edad dominante fue rango de ˃60 años con 60% (6), según su cronología tiene predominio en un 100% (10) para recurrencia tardía. Según escala de Campanellí la mayor frecuencia fue de R2 con un total de 60% (6) de tipo indirecta; con 60% (6) tipo directa según la escala de Nyhus y su localización anatómica con un 70% (7) casos fue lado derecho. La técnica más utilizada en la primera intervención quirúrgica fue la de Lichtenstein en un 71% (97) casos y la más utilizada en la primera intervención quirúrgica de hernia inguinal recurrente es la técnica de Bassini con 40% (4), de acuerdo con otros estudios se afirma que es la que más presenta recurrencia en comparación de la técnica Lichtenstein con 10% (1).

Recurrencia de hernias inguinales en el Hospital de Chiquimula

Se denomina recurrencia o recidiva al desarrollo de una nueva hernia independientemente del sitio anatómico, con la única condición de que sea del mismo lado operado previamente. El estudio realizado fue de tipo descriptivo retrospectivo, con el objetivo de determinar la recurrencia de las hernias inguinales de acuerdo a las técnicas de reparación quirúrgica en los pacientes postoperados en el Servicio de Cirugía General de adultos del Hospital Nacional de Chiquimula de enero de 2013 a diciembre de 2017. La información obtenida fue por medio de la ficha recolección datos, que ayudó a determinar una alta recurrencia de hernia inguinal con un 8% de 59 casos que fueron intervenidos por hernia inguinal, el 100% corresponden al sexo masculino, la edad dominante fue rango de 31 a 59 años con el 60% (3); según su cronología tiene predominio en un 80% (4) para recurrencia tardía. La técnica más utilizada en la primera intervención quirúrgica de pacientes con hernia inguinal fue un 64% (38) la técnica de Lichtenstein y la más utilizada en la primera intervención quirúrgica de hernia inguinal recurrente incluye otros con 60% (3). Se socializaron los resultados obtenidos con los cirujanos, estudiantes de medicina, la Dirección del Hospital Nacional de Chiquimula y pacientes ingresados postoperados de hernia inguinal.

Does the adoption of an emergency general surgery service model influence volume of cholecystectomies at a tertiary care center.

The purpose of this study was to evaluate the rate of cholecystectomy before and after adoption of an emergency general surgery (EGS) model at our institution. A longitudinal, observational study was conducted prior to and following introduction of an EGS model at our institution. Using the New York SPARCS Administrative Database, all adult patients presenting to the emergency department with gallbladder-related emergencies were identified. The rates of laparoscopic and open cholecystectomies performed 3years prior and 3years following the adoption of the EGS model were examined. A multivariable logistic regression model was used to compare the incidence of cholecystectomy at initial ED visit at our institution pre- and post-EGS introduction as well as to those in the rest of the state as an external control group, while adjusting for potentially confounding factors. There were 176,159 total ED visits of patients with gallbladder emergencies (154,743 excluding repeat presenters) in the studied period in NY State. Of these, 63,912 patients (41.3%) had a concurrent cholecystectomy in NY State. The rate of cholecystectomy at these institutions remained relatively steady from 38.8% from 2010 to 2013 and 38.6% from 2013 to 2016. At our institution, there were 2039 gallbladder emergencies, and of those 755 underwent cholecystectomy. At our institution, there was an increase from 28.21% 3years prior to the adoption of the EGS model to 40.2% in the following 3years (RR = 1.06, 95% CI 1.0164-1.1078, p = 0.0069). The initiation of the EGS model at a tertiary center was associated with a significant increase in the number of concurrent cholecystectomies from 28.21 to 40.2% over a 6-year period. This change was accompanied by an increase in the number of patient comorbidities and a lower insurance status.

Impact of acute care surgery on timeliness of care and patient outcomes: a systematic review of the literature

Dedicated emergency general surgery (EGS) service models were developed to improve efficiency of care and patient outcomes. The degree to which the EGS model delivers these benefits is debated. We performed a systematic review of the literature to identify whether the EGS service model is associated with greater efficiency and improved outcomes compared to the traditional model. We searched MEDLINE, Embase, Scopus and Web of Science (Core Collection) databases from their earliest date of coverage through March 2017. Primary outcomes for efficiency of care were surgical response time, time to operation and total length of stay in hospital. The primary outcome for evaluating patient outcomes was total complication rate. The EGS service model generally improved efficiency of care and patient outcomes, but the outcome variables reported in the literature varied. Development of standardized metrics and comprehensive EGS databases would support quality control and performance improvement in EGS systems.

2019 Canadian Surgery Forum Abstracts.

# 01. The future of general surgery training: a Canadian resident nationwide Delphi consensus statement {#article-title-2} Various pedagogical models have been introduced in an attempt to improve and restructure surgical training, but significant obstacles remain. Before implementing national

A sub-specialised emergency general surgery on call can improve theatre utilisation

Background: Theatre efficiency and delivery of a safe emergency general surgery service are important topics in the current climate of limited funding and resources. No studies have examined the impact of restructuring a general surgery emergency on call system on theatre utilisation and efficiency.Methods: Data was collected for twelve months prior and twelve months after the introduction of a sub-specialised on call system on operating minutes, out of hours operating and which procedures were done after 10 PM using a prospectively maintained database. Theatre utilisation was calculated and compared using a paired T test.Results: In 2012, between 8 AM and 5 PM, 993 emergency procedures were done in 2012 compared 1300 in 2015 corresponding to 34585 and 90311 minutes of operating respectively and 17.5% and 45.8% of total theatre time available (p&lt;0.05). 160 procedures in 2012 were performed after 10 PM and 106 in 2015 corresponding to 16457 and 9341 minutes respectively (p&lt;0.0001).Conclusions: A sub-specialised emergency general surgery on call system can improve theatre utilisation.