Kristin DeGirolamo1, Karan D'Souza1, Sameer Apte1, Chad G Ball1, Christopher Armstrong1, Artan Reso1, Sandy Widder1, Sarah Mueller1, Lawrence M Gillman1, Ravinder Singh1, Rahima Nenshi1, Kosar Khwaja1, Samuel Minor1, Chris de Gara1, S Morad Hameed1. 1. From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed).
Abstract
BACKGROUND: Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case-mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS: A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected. RESULTS: Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case-mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]). CONCLUSION: The characteristics and case-mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.
BACKGROUND: Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case-mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS: A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected. RESULTS: Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case-mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]). CONCLUSION: The characteristics and case-mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.
Authors: Adnan Qureshi; Andy Smith; Frances Wright; Fred Brenneman; Sandro Rizoli; Taulee Hsieh; Homer C Tien Journal: J Am Coll Surg Date: 2011-05-20 Impact factor: 6.113
Authors: Lena M Napolitano; Gerard J Fulda; Kimberly A Davis; Dennis W Ashley; Randall Friese; Charles W Van Way; J Wayne Meredith; Timothy C Fabian; Gregory J Jurkovich; Andrew B Peitzman Journal: J Trauma Date: 2010-12