American Surgical Association
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An Acute Care Surgery Model Improves Outcomes in Patients with Appendicitis
C. William Schwab, MD, John P. Pryor, MD*, Angela S. Earley, MD*, Patrick Kim, MD*, Joseph H. Hedrick, MD*, Seema Sonnad, PhD*, Jibby E. Kurichi, MPH*, Amy C. Minogue, BA*, Patrick M. Reilly, MD*
University of Pennsylvania, Phialdelphia, PA

OBJECTIVE: Acute Care Surgery (ACS) has been proposed as a practice model for the future of general surgery. To date, there is little evidence regarding outcomes of surgical emergencies in the ACS model. We compared outcomes of appendectomy in an ACS model to that of a traditional home-call attending surgeon model at an academic hospital.
METHODS: Between Aug. 2000 and Sept. 2001, surgical emergencies were staffed at faculty level by either an in-house Trauma/Emergency surgeon (ACS model) or a non-Trauma general surgeon taking home call (Traditional model). Call duties alternated monthly. Other aspects of hospital care, including resident complement, remained unchanged. We retrospectively reviewed interval from emergency room (ER) admission to initial surgical consultation, interval from ER admission to operating room (OR), length of stay (LOS), complication rate, rupture rate and negative appendectomy rate. Statistics included Chi square test for discrete variables and independent sample t-test for comparison of means.
RESULTS: During the study period, 298 appendectomies were performed, summarized below.
ACS modelTraditional modelp-value
ER admit to consult6.59 hours6.41 hoursNS
ER admit to OR9.83 hours13.97 hours0.03
LOS2.3 days3.5 days< 0.001
Complication rate7.7%17.8%0.02
Rupture rate12.3%23.3%0.03
Pathology negative10.6%12.2%NS

CONCLUSIONS: In patients with acute appendicitis, the presence of an in-house Trauma/Emergency surgeon significantly decreased the time to operation, length of stay, complication rate, and rupture rate, without a difference in the negative appendectomy rate. The ACS model appears to improve outcomes of acute appendicitis compared to a traditional home call model. This study supports the efficacy of the ACS model in the management of surgical emergencies.

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