Objective: To assess the outcomes of appendicectomy in an acute care surgery (ACS) model compared with a traditional on‐call (Trad) model. Design: Retrospective historical control study comparing appendicectomy outcomes in the Trad period (April 2004 to March 2005) with outcomes in the ACS period (April 2006 to March 2007). Setting: The Prince of Wales Public Hospital, a metropolitan tertiary referral centre in Sydney. Patients: All adult patients undergoing appendicectomy during 1‐year periods before and after the introduction of the ACS model. Intervention: The introduction of an ACS model for managing all emergency general surgical presentations. Main outcome measure: Complication rate. Results: A total of 402 appendicectomies were performed, 176 during the Trad period and 226 during the ACS period. There was no perioperative mortality. The complication rate was lower in the ACS period than the Trad period (9.3% v 17.0%; P = 0.02). After the intervention, there was no significant change in the time from presentation to arrival in theatre or in length of stay, but the proportion of operations performed at night (24:00–08:00) was reduced from 26.1% to 15.0% (P = 0.006). The proportion of negative appendicectomies was reduced from 22.7% to 17.3%, but the change was not statistically significant (P = 0.08). There was no difference in perforation rate before and after the intervention (13.6% v 13.3%; P = 0.86). Conclusion: The ACS model provides a safe surgical environment for patients and is associated with a reduced complication rate. Under the ACS model, there was an increase in the number of patients treated conservatively overnight, but this did not lead to an overall increase in perforation rate or length of stay.