Re: Is the acute surgical unit model feasible for Australian regional centres?

Jaboury, Imad A.

doi:10.1111/ans.13902

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…Following the first Australian implementation in 2005, 11 hospitals nationally have reported their outcomes using this structure . This may represent under‐reporting or reluctance to change due to concerns over the ASU model's benefit, cost or suitability to a particular institution . Larger studies such as this which demonstrate an improvement in patient outcome may provide encouragement to policymakers and hospitals still employing a Traditional model.…”

Section: Discussionmentioning

confidence: 99%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

ANZ Journal of Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

ANZ Journal of Surgery

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Emergency laparotomy outcomes before and after the introduction of an acute surgical unit

Guy

Lisec

2018

International Journal of Surgery Open

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Introduction: Emergency laparotomy is associated with significant morbidity and mortality. This study compared emergency laparotomy outcomes in a traditional service to those after the introduction of an Acute Surgical Unit (ASU). Methods: A retrospective cohort study was performed by reviewing the medical records of all individuals that had an emergency laparotomy in twelve-month periods before and after the introduction of an ASU. Outcomes included time to surgical review, operation duration, length of stay, complications and mortality. Morbidity and mortality were compared to that predicted by P-Possum scores. Results: In the pre-ASU group there were 58 participants (26 males, 32 females) with a median age of 60 years (range 15–87) and median P-Possum predicted morbidity and mortality of 68% (18–98%) and 6% (1–66%) respectively. In the post-ASU group there were 109 participants (58 males, 53 females) with a median age of 63 years (range 11–100), and median P-Possum predicted morbidity and mortality of 82% (18–100%) and 12% (1–99%). Operating time decreased post-ASU (median 1 hr 31 min pre vs 1 hr 15 min post p = 0.030) and there was a reduction in the incidence of post-operative fistula formation (5% vs 0% p = 0.017). There were no other significant differences in morbidity or mortality. Conclusions: The post-ASU cohort had shorter operative duration and reduced incidence of complicating fistulas but no other significant difference in outcomes. Further studies may define the impact of an ASU on clinical decision making, service delivery, morbidity and mortality in patients that undergo emergency laparotomy. Highlights:

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