Management of Appendicitis with the Implementation of an Acute Care Surgery Service in a Community Teaching Hospital

摘要

Appendicitis remains one of the most common conditions requiring emergency general surgery intervention. Previous studies have assessed the utility of acute care surgery (ACS) teams for the management of emergency general surgery at the university level. This study compares outcomes for acute appendicitis in a traditional on-call (TOC) model with private practice general surgeon coverage versus an ACS model, using these same general surgeons in a community teaching hospital. We performed a retrospective review of 3254 patients treated for acute appendicitis from 2006 to 2014, during which time, an ACS model was implemented. The primary outcome is length of stay. Secondary outcomes include time interval from case posting to entering operating room, operative time, procedure performed, and complications. This study demonstrates significant decreases in time intervals including a shorter length of stay (median 22.8 vs 27.9 hours, P < 0.001), shorter time to start surgery (median 1.5 vs 1.6 hours, P 4 0.02 if request start within 2 hours; median 2.5 vs 3.0 hours, P 4 0.04 if request start within 4 hours), and shorter operative time (median 40 vs 46 min, P < 0.001). Both cohorts were most likely to perform a laparoscopic intervention, but the ACS group was less likely to convert to an open procedure (4 vs 5%, P < 0.001), and the rate of complications was similar in both groups (5 vs 7%, P 4 0.07). Overall, this study shows that an ACS model can expedite care and provide high-quality care, with equivalent outcomes, when compared with a traditional on-call model in a community hospital with private practice general surgeons.. ^e>mfarrellmd@gmail.com