The Established Acute Surgical Unit: A reduction in nighttime appendicectomy without increased morbidity

Allaway, Matthew G R; Eslick, Guy D.; Kwok, Grace; Cox, Michael R.

doi:10.1016/j.ijsu.2017.05.045

Cited by 16 publications

(27 citation statements)

References 35 publications

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“…This is consistent with data from a recent meta‐analysis which showed that delaying surgery for presumed uncomplicated appendicitis for up to 24 hours after admission did not result in more complications . Our results also showed that the proportion of operations performed overnight was significantly lower in the contemporary cohort without any obvious adverse consequences, reinforcing the findings of Allaway et al . in their 5‐year follow‐up study of appendicectomy outcomes following the implementation of an ACS model at Nepean Hospital.…”

Section: Discussionsupporting

confidence: 89%

“…There have not been other substantive changes to the local health service over this time. This contrasts with other ACS units who have experienced substantially increased workload and commensurate expansion of resources such as the number of emergency theatres . One weakness of this study is that several potentially important confounders, such as patient comorbidities and socioeconomic status and the level of experience of the primary proceduralist, were not measured.…”

Section: Discussionmentioning

confidence: 92%

“…This contrasts with other ACS units who have experienced substantially increased workload and commensurate expansion of resources such as the number of emergency theatres. 16 One weakness of this study is that several potentially important confounders, such as patient comorbidities and socioeconomic status and the level of experience of the primary proceduralist, were not measured. The protocols of the original ACS studies did not require collection of this data, and so, it was not possible to control for these factors during our analysis.…”

Section: Discussionmentioning

confidence: 99%

“…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. Nepean Hospital in Sydney implemented an ACS model around the same time as our institution and showed, in a 5‐year follow‐up study of non‐elective appendicectomy, that a reduction in overnight operating could be sustained without detriment to the complication rate or length of stay . To our knowledge, no other studies have reported on the long‐term outcomes of units that have implemented an ACS model.…”

Section: Introductionmentioning

confidence: 90%

“…Nepean Hospital in Sydney implemented an ACS model around the same time as our institution and showed, in a 5-year follow-up study of non-elective appendicectomy, that a reduction in overnight operating could be sustained without detriment to the complication rate or length of stay. 16 To our knowledge, no other studies have reported on the long-term outcomes of units that have implemented an ACS model.…”

Section: Introductionmentioning

confidence: 99%

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

Kaya

Yang

Wong

et al. 2020

ANZ Journal of Surgery

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

Kaya

Yang

Wong

et al. 2020

ANZ Journal of Surgery

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The Unacceptable Morbidity of Negative Laparoscopic Appendicectomy

2018

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Early Laparoscopic Washout may Resolve Persistent Intra‐abdominal Infection Post‐appendicectomy

et al. 2018

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Background Intra-abdominal abscess (IAA) complicates 2-3% of patients having an appendicectomy. The usual management is prolonged antibiotics and drainage of the IAA. From 2006, our unit chose to use early re-laparoscopy and washout in patients with persistent sepsis following appendicectomy. The aims of this study were to assess the outcomes of early laparoscopic washout in patients with features of persistent intra-abdominal sepsis and compare those with percutaneous drainage and open drainage of post-appendicectomy IAA. Methods A retrospective case note review was performed for all patients having a laparoscopic washout, percutaneous drainage or open drainage following appendicectomy between January 2006 and December 2017. Results During the period, 4901 appendicectomies occurred. Forty-one (0.8%) patients had a laparoscopic washout, 16 (0.3%) had percutaneous drainage, and 6 (0.1%) had an open drainage. The demographics, ASA grade and pathology at initial appendicectomy were similar. The mean time after appendicectomy was significantly shorter for laparoscopic washout (4.1 days vs. 10.1 and 9.0 days, p = \0.003). The mean time for resolution of SIRS was significantly shorter (2.0 days vs. 3.3 and 5.2 days, p \0.02). The morbidity and length of stay were similar. Conclusion Early laparoscopic washout for persistent intra-abdominal sepsis may be an alternative to non-operative management and delayed intervention for IAA and may have better outcomes than either percutaneous drainage or open drainage. A prospective randomised comparison is required to further evaluate the indications and role of early laparoscopic washout post-appendicectomy.

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The Established Acute Surgical Unit: A reduction in nighttime appendicectomy without increased morbidity

Abstract: IIb.

Cited by 16 publications

References 35 publications

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

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

The Unacceptable Morbidity of Negative Laparoscopic Appendicectomy

Early Laparoscopic Washout may Resolve Persistent Intra‐abdominal Infection Post‐appendicectomy

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