M. N. Khan1, M. Hamidi1, A. Jain1, E. Zakaria1, N. Kulvatunyou1, T. O’Keeffe1, A. Tang1, L. Gries1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA
Introduction:
Trauma services are increasingly providing emergency surgery (ES) care by developing “acute care surgery service (ACS)” which is a combination of trauma surgery, broad-based ES, and surgical critical care. ACS implementation has been shown to provide timely care with improved patients outcomes. The aim of our study was to evaluate the impact of ACS on outcomes in patients who underwent ES for acute diverticulitis
Methods:
We reviewed all patients who were admitted with the diagnosis of acute diverticulitis from 2009-2014. Patients who underwent ES (within 24 hours of hospital admission) were included while those who were admitted during ACS implementation year (2011) were excluded. Patients were divided into two groups: (Pre-ACS [2009-2010] and Post-ACS [2012-2014] and were matched in a 1:2 ratio using propensity score matching for demographics, comorbidities and admission vitals and labs. Outcome measures were time to evaluation by the surgeon, time to operating room (OR) from emergency department (ED), hospital length of stay (LOS), complications, mortality and adjusted hospital charges.
Results:
A total of 1216 patients were analyzed. 284 patients underwent operative intervention within 24 hours of admission, of which 207 patients (Pre-ACS, 69; Post-ACS, 138) were matched. Patients in ACS group had lower median time to evaluation by the surgeon (150 minutes vs 313 minutes, p<0.001), less median time to OR from ED (8.3 hours vs 12.4 hours, p<0.001), less median hospital LOS (6.3 days vs 8.1 days, p=0.02) and a less median hospital charges ($52,252 vs $59,543, p<0.001) as compared to the pre-ACS group. However, there was no difference in complications rate (35% vs 37%, p=0.12) and mortality rate (5% vs 6.6%, p=0.18) between the two cohorts.
Conclusion:
Acute care surgery model implementation at our institution lead to earlier time to evaluation by surgeon, less time to OR from ED, a shorter length of hospital stay, and reduction in hospital charges. Acute care surgery model results in better patient outcomes and improved utilization of hospital resources in patients undergoing operative intervention for acute diverticulitis.