Patrick B Murphy1, Kristin DeGirolamo2, Theunis Jean Van Zyl3, Laura Allen1, Elliott Haut4, W Robert Leeper5, Ken Leslie1, Neil Parry5, Morad Hameed6, Kelly N Vogt7. 1. Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada. 2. Department of General Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. 3. Faculty of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada. 4. Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Division of Trauma and Acute Care Surgery, Johns Hopkins University, Baltimore, MD. 5. Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Trauma Program, London Health Sciences Centre, London, ON, Canada. 6. Department of General Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. 7. Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Trauma Program, London Health Sciences Centre, London, ON, Canada. Electronic address: kelly.vogt@lhsc.on.ca.
Abstract
BACKGROUND: The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured emergency general surgery patient population, however, there are variations in the design of ACS service models. This meta-analysis analyzes the impact of implementation of different ACS models on the outcomes for appendicitis and biliary disease. STUDY DESIGN: A systematic, English-language search of major databases was conducted. From 1,827 papers, 2 independent reviewers identified 25 studies that reported on outcomes for patients with appendicitis (n = 13), biliary disease (n = 7), or both (n = 5), before and after implementation of an ACS service. The Newcastle-Ottawa Scale was used to score quality. Outcomes were analyzed using random effect methodology and sensitivity analyses were performed. RESULTS: Significant heterogeneity existed between studies and ACS designs. The overall study quality rating was fair to poor with a moderate risk of bias. After implementation of an ACS service, there was an overall reduction in length of stay by 0.51 days (95% CI -0.81 to -0.20 days) and 0.73 days (95% CI 0.09 to 1.36 days) for appendicitis and biliary disease, respectively. Complication rates were lower after implementing ACS (odds ratio 0.65; 95% CI 0.49 to 0.86 and odds ratio 0.46; 95% CI 0.34 to 0.61). There was no difference in after-hours operating for either appendicitis or biliary disease, except when considering ACS models with dedicated theater time, which favors an ACS model (odds ratio 0.49; 95% CI 0.33 to 0.73) in appendicitis. CONCLUSIONS: The ACS model has been shown to benefit acute care surgery patients with improved access to care, fewer complications, and decreased length of stay for 2 common disease processes. The design and implementation of an ACS service can impact the magnitude of effect.
BACKGROUND: The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured emergency general surgery patient population, however, there are variations in the design of ACS service models. This meta-analysis analyzes the impact of implementation of different ACS models on the outcomes for appendicitis and biliary disease. STUDY DESIGN: A systematic, English-language search of major databases was conducted. From 1,827 papers, 2 independent reviewers identified 25 studies that reported on outcomes for patients with appendicitis (n = 13), biliary disease (n = 7), or both (n = 5), before and after implementation of an ACS service. The Newcastle-Ottawa Scale was used to score quality. Outcomes were analyzed using random effect methodology and sensitivity analyses were performed. RESULTS: Significant heterogeneity existed between studies and ACS designs. The overall study quality rating was fair to poor with a moderate risk of bias. After implementation of an ACS service, there was an overall reduction in length of stay by 0.51 days (95% CI -0.81 to -0.20 days) and 0.73 days (95% CI 0.09 to 1.36 days) for appendicitis and biliary disease, respectively. Complication rates were lower after implementing ACS (odds ratio 0.65; 95% CI 0.49 to 0.86 and odds ratio 0.46; 95% CI 0.34 to 0.61). There was no difference in after-hours operating for either appendicitis or biliary disease, except when considering ACS models with dedicated theater time, which favors an ACS model (odds ratio 0.49; 95% CI 0.33 to 0.73) in appendicitis. CONCLUSIONS: The ACS model has been shown to benefit acute care surgery patients with improved access to care, fewer complications, and decreased length of stay for 2 common disease processes. The design and implementation of an ACS service can impact the magnitude of effect.
Authors: Doris Sarmiento Altamirano; Amber Himmler; Oscar Chango Sigüenza; Raúl Pino Andrade; Nube Flores Lazo; Jeovanni Reinoso Naranjo; Hernán Sacoto Aguilar; Lenin Fernández de Córdova; Edgar Rodas; Juan Carlos Puyana; Juan Carlos Salamea Molina Journal: World J Surg Date: 2020-06 Impact factor: 3.352
Authors: Chad G. Ball; Patrick Murphy; Kevin Verhoeff; Omar Albusadi; Matthew Patterson; Sandy Widder; S. Morad Hameed; Neil Parry; Kelly Vogt; John B. Kortbeek; Anthony R. MacLean; Paul T. Engels; Timothy Rice; Rahima Nenshi; Kosar Khwaja; Samuel Minor Journal: Can J Surg Date: 2020-03-27 Impact factor: 2.089
Authors: Alexis L Cralley; Clay C Burlew; Charles J Fox; Fredric M Pieracci; K Barry K Platnick; Eric M Campion; Mitchell J Cohen; Ernest E Moore; Ryan A Lawless Journal: JSLS Date: 2022 Jul-Sep Impact factor: 1.789