The impact of implementation of an Acute Care Surgery service on emergency general surgery outcomes at our institution
Georges Tahan1, Emily Straley1, Sarah Kelso1, Michaela Forgione2, Joan Skelly1, Wasef Abu-Jaish1
1Larner College of Medicine , UVMMC, Burlington, Vermont, United States, 2University of Vermont, Burlington, Vermont, United States
Objective: To investigate outcomes and efficiency in emergent appendectomies and cholecystectomies performed four years pre and post implementation of a novel Acute Care Surgery (ACS) service at our institution. Design: A retrospective review and analysis of our institution's admission and discharge data for all patients presenting to the emergency department for emergent appendectomy or cholecystectomy was conducted from October 2011 to October 2019. Setting: The University of Vermont Medical Center (UVMMC) is an academic, nonprofit, 562 bed hospital and a designated Level I trauma center, which implemented an ACS service in October 2015. Patients: 1450 appendectomy cases were identified, with 738 pre- and 712 post-implementation of an ACS service. 706 emergent cholecystectomy cases were identified, 300 cases pre- and 406 post-implementation of an ACS service. Interventions: None. Main Outcome Measure(s): Patient demographics and key time intervals including time from emergency department (ED) presentation to surgical consult, surgical consult to the operating room (OR), overall time from ED to the OR, length of stay (LOS), conversion rate from laparoscopic to open procedure, and 30-day readmission rates. Results: Common comorbidities identified were obesity (8% and 22%), diabetes (4% and 9%), and cardiac (4% and 8%) for appendectomy and cholecystectomy, respectively. Overall time from ED presentation to the OR was 7 hours 38 minutes and 18 hours 47 minutes pre-ACS implementation for appendectomy and cholecystectomy, and 11 hours 31 minutes and 23 hours 27 minutes post-ACS implementation. Average index length of stay (LOS) was 1.43 (± 1.37 days) and 2.22 (± 2.38 days) pre-ACS implementation, and 1.71 (± 2.30) and 2.06 (± 1.97 days) post ACS for appendectomies and cholecystectomies respectively. There was no statistically significant difference in either cohort in overall LOS or readmission rates when comparing pre- and post-ACS implementation data. Conclusions: Implementation of a novel ACS service at our institution resulted in a significant increase in time from surgical consult to the OR for both emergent appendectomies and cholecystectomies (p=<0.0001). However, there was no statistically significant difference in patient outcomes as determined by LOS and readmission rates between the traditional emergency service and the novel ACS service. These findings underscore the necessity of creating clear guidelines for implementation of novel ACS services to allow for comparison and large-scale analyses of ACS services across numerous institutions.
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