V. Strickland1, R. Griffin2, R. Uhlich1, P. Hu1, J. Kerby1, J. Jansen1 1University Of Alabama at Birmingham,Acute Care Surgery/Surgery,Birmingham, Alabama, USA 2University Of Alabama at Birmingham,Epidemiology,Birmingham, Alabama, USA
Introduction: The past decade has seen a change in the delivery of emergency general surgery (EGS) services, with many hospitals adopting the Acute Care Surgery model. Previous work has suggested that initiation of EGS may increase the productivity of both elective and emergency general surgery services. However, the impact of this change has not been evaluated in detail. We sought to evaluate the number of patients admitted, the number of operative cases, time to operating room, and length of stay before and after implementation of a dedicated Emergency General Surgery service at our academic medical center.
Methods: Patients admitted emergently with discharge diagnosis of acute appendicitis, acute cholecystitis, pancreatitis,small bowel obstruction, colorectal cancer, or acute diverticulitis were included. Patients admitted between January 2013 and June 2015 (i.e., pre-EGS service) and between January 2016 and June 2018 (i.e., post-EGS service) were included in this quasi-experimental study, with July to December 2015 designated as the “wash-in” period, when the service was established. Secular trends in the monthly patient case load were compared between periods using Poisson regression, and trends in time to first surgery (in hours) and overall hospital length of stay (in days) were compared using a linear regression. A Wilcoxon rank sums test was used to compare the distribution of time to first surgery and length of stay between study periods.
Results: A total of 1017 patients were identified, 547 pre-EGS and 470 post-EGS. We found no difference in number of patients admitted or undergoing operative intervention pre/post-EGS periods (399 pre-EGS vs. 361 post-EGS, p=0.163). We did find a decrease in time to first surgery from admission, with post-EGS time to surgery being 5 hours sooner (15.1 hours to surgery pre-EGS vs. 9.9 hours post-EGS service, p<0.0001). There was also a decrease in the median length of stay (LOS) for the post-EGS period when compared with pre-EGS period (pre-EGS LOS 2.9 days and post-EGS LOS of 2.5, p=0.0163).
Conclusion: The development of an EGS service in our hospital did not impact the number of patients admitted, or the number of patients undergoing operative intervention. However, we did see a statistically significant decrease in time to operating room as well as a decrease in the median length of stay comparing before and after implementation of EGS service. Further evaluating of the impact of service change in emergency general surgical patients is warranted.