Efficiency of care and cost for common emergency general surgery conditions: Comparison by surgeon training and practice

Ladhani, Husayn A; Posillico, Sarah E; Zosa, Brenda M.; Verbus, Emily; Brandt, Christopher P.; Claridge, Jeffrey A.

doi:10.1016/j.surg.2018.05.048

Cited by 5 publications

(5 citation statements)

References 18 publications

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Section: Resultsmentioning

confidence: 99%

“…Eighteen studies described ACS models in the USA [5–8, 10–14, 16–20, 25–28]. The majority of studies described a dedicated ACS service with daytime on‐site attending coverage, and dedicated resident rotations [5, 7, 8, 10, 11, 14, 28]. Most models provided trauma [7, 8, 10, 11, 14, 17–20, 25, 27]—and/or critical care [6, 7, 10, 11, 18–20, 25, 27], seven studies reported a completely separate service or subunit [5–7, 10, 16, 19, 20].…”

Section: Resultsmentioning

confidence: 99%

“…Most models provided trauma [7, 8, 10, 11, 14, 17–20, 25, 27]—and/or critical care [6, 7, 10, 11, 18–20, 25, 27], seven studies reported a completely separate service or subunit [5–7, 10, 16, 19, 20]. The elective duties of attending surgeons were cleared in seven, [5, 6, 12–14, 20, 28] eight had protected operating room (OR) time, [6, 8, 11, 13, 14, 19, 26, 27], and six provided ED coverage by attendings and/or residents [5–7, 14, 17, 20]. These components were not frequently described in other articles.…”

Section: Resultsmentioning

confidence: 99%

“…These components were not frequently described in other articles. Only two articles reported ACS surgeons were trained to provide critical care but did not specifically describe ICU coverage [26, 28].…”

Section: Resultsmentioning

confidence: 99%

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Acute Care Surgery Models Worldwide: A Systematic Review

2020

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Background The Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide. Methods A literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles. Results The search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care. Conclusions Large national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra-and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Acute Care Surgery Models Worldwide: A Systematic Review

2020

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“…The awareness and acknowledgment of the special needs and time sensitiveness of EGS patients leads to the implementation of designated acute care surgical teams aiming for increased continuity of care. Moreover, it has been showed that trauma and critical care trained surgeons provide more efficient care to patients suffering from EGS conditions compared to boarded-certified general surgeons with or without subspeciality titles (e.g., less time from ED to the OR) [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

Quaile

Perrodin

Trippel

et al. 2023

Eur J Trauma Emerg Surg

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Objective Running an emergency general surgery (EGS) service is challenging and requires significant personnel and institutional resources. The aim of this study was to achieve a nationwide overview of the individual EGS service organizations in public hospitals in Switzerland. Methods All Swiss public hospitals with a surgical and emergency department were included and contacted by telephone. General surgeons were interviewed between December 2021 and January 2022 using a standardized questionnaire. Results Seventy-two out of 79 public hospitals in Switzerland (91.1%) agreed to the survey. They employed 1,581 surgeons in 19 (26.4%) hospitals with < 100 beds, 39 (54.2%) hospitals with 100–300 beds, 7 (9.7%) with 300–600 beds, and 7 (9.7%) with > 600 beds. The median number of surgeons per hospital was 20.5 (IQR 13.0–29.0). Higher level of care (intermediate or intensive care unit) was significantly less available in small hospitals (< 100 beds). The median hour of designated emergency operating room capacity per day was 14 h (IQR 14–24) for all hospitals with < 600 beds and 24 h (IQR 14–24) for the largest hospitals (> 600 beds). With increasing hospital size, there was a significant increase in the number of surgical units where EGS and orthopedic trauma surgery were covered by two separate teams (21.1% vs. 43.6% vs. 85.7% vs. 100%, p = 0.035). The median number of surgeons on-call per hospital and per 24 h was 5.0 (IQR 3.3–6.0). Conclusion Lack of higher level of care in small hospitals, limited emergency OR capacity and short rotations of on-call teams are major drawbacks of many current EGS systems in Switzerland. Centralization of critically ill EGS patients and reorganization of surgical on-call systems to designated acute care surgery teams should be considered.

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The Economic Burden of Emergency Abdominal Surgery in the Elderly: What Is the Role of Laparoscopy?

Vagnoni

2021

Emergency Laparoscopic Surgery in the Elderly and Frail Patient

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Efficiency of care and cost for common emergency general surgery conditions: Comparison by surgeon training and practice

Cited by 5 publications

References 18 publications

Acute Care Surgery Models Worldwide: A Systematic Review

Acute Care Surgery Models Worldwide: A Systematic Review

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

The Economic Burden of Emergency Abdominal Surgery in the Elderly: What Is the Role of Laparoscopy?

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