Emergency Management of Gallbladder Disease: Are Acute Surgical Units the New Gold Standard?

Kinnear

et al. 2018

Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Impact of an acute surgical unit on outcomes in acute cholecystitis

Kinnear

et al. 2018

“…While increased patient load compared to earlier years might be expected, this has not been the case in some ASU cohorts . For those ASUs that did experience greater throughput, equivalent or superior results for the three key outcomes of time to theatre, daytime operating and length of stay were maintained by most but not all sites …”

Section: Discussionmentioning

confidence: 97%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

Background: Few large Australian studies have explored the impact of acute surgical unit (ASU) model in appendicitis.Methods: An ASU model commenced practice at our institution on 1 August 2012. In this retrospective cohort study, patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. Primary outcomes were median length of stay, median time from emergency department referral to theatre start and proportion of cases performed in-hours. Secondary outcomes were rates of complications, open appendicectomy, consultant scrubbed for procedure, intensive care unit admission and re-presentation to emergency department within 30 days. Results: After removing those with incomplete data, 1214 patients were enrolled; 465 in the Traditional group and 749 in the ASU group. There were no significant baseline differences between groups. Compared with the Traditional group, ASU patients had similar length of stay (1.81 versus 1.81 days; P = 0.54) and time to theatre (0.59 versus 0.56 days; P = 0.14), but a greater proportion of in-hours operation (72% versus 79%; P = 0.014). The ASU group also experienced fewer complications (9% versus 6%; P = 0.031), fewer primary open (4% versus 1%; P < 0.0001) or conversion-to-open appendicectomies (6% versus 2%; P < 0.0005) and had superior rates of consultant scrubbed in theatre (21% versus 56%; P < 0.00001). Rates of intensive care unit admission (1% versus 1%; P = 0.72) and re-presentation were unchanged (5% versus 5%; P = 0.46). Conclusion: In our institution, the introduction of an ASU model was associated with more in-hours operations and safer care for patients undergoing appendicectomy.

“…[4][5][6][7]14 Complication rates were reduced 5 or unchanged. 6,14 For non-elective cholecystectomy, wait times to surgery and lengths of stay were usually reduced following the implementation of an ACS model, 10,15 although most studies reported no difference in the complication rate. 9,10,15 Most studies used a repeated cross-sectional design to assess the immediate impact of implementing an ACS model, but few have provided data on whether these outcomes have endured.…”

Section: Introductionmentioning

confidence: 99%

“…6,14 For non-elective cholecystectomy, wait times to surgery and lengths of stay were usually reduced following the implementation of an ACS model, 10,15 although most studies reported no difference in the complication rate. 9,10,15 Most studies used a repeated cross-sectional design to assess the immediate impact of implementing an ACS model, but few have provided data on whether these outcomes have endured. It is possible that improvements only last during the period of change following the introduction of a new system due to increased surveillance and staff awareness, a phenomenon known as the Hawthorne effect.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of an acute care surgery model: a 10‐year follow‐up study

Kaya

Yang

Wong

et al. 2020

Background Many hospitals across Australia and New Zealand have implemented acute care surgery (ACS) models over the past decade, often with improved outcomes such as reductions in wait time to surgery, complications and length of stay. The aim of this study was to evaluate the outcomes of patients who underwent non‐elective appendicectomy and cholecystectomy and compare these with the results observed shortly after the implementation of an ACS model at our institution 10 years earlier. Methods A retrospective review of contemporary patients who underwent non‐elective appendicectomy and cholecystectomy compared with historical data was performed. Primary outcomes were wait time to surgery, surgical complications and length of stay. Results In the contemporary cohort, 263 patients underwent non‐elective appendicectomy over a 1‐year period compared with 226 patients in the historical cohort. The median wait time to surgery had increased (17.7 versus 9.6 h, P < 0.001). There was no significant difference in a composite end‐point of complications and readmissions (8.0% versus 9.3%, P = 0.61). The length of stay was unchanged. There was greater use of preoperative imaging and reduced overnight operating. For non‐elective cholecystectomies, 132 patients underwent this procedure in the contemporary cohort over a 2‐year period compared with 115 patients in the historical cohort. There were no significant differences in wait time to surgery (2 versus 1 day, P = 0.13) or complications (9.8% versus 8.7%, P = 0.75). The length of stay was unchanged. Conclusion The majority of improvements seen shortly following the implementation of an ACS model have been sustained after 10 years.