The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home-call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on-site consultant. In addition, the ACS model provides greater consultant supervision to the trainee.

Simple transverse resection is not recommended for the short Meckel's diverticulum. A HDR of 2.0 is recommended as the cut-off when deciding on the most appropriate operation. The external appearance of the Meckel's diverticulum does not predict the presence of HGM and is therefore an unreliable indicator to aid resection decisions when presented with an incidental Meckel's diverticulum.

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.

The operating theatre is a complex place. There are many potential factors which can interfere with surgery and predispose to errors. Optimizing the operating theatre environment can enhance surgeon performance, which can ultimately improve patient outcomes. These factors include the physical environment (such as noise and light), human factors (such as ergonomics), and surgeon-related factors (such as fatigue and stress). As individual factors, they may not affect surgical outcome but in combination, they may exert a significant influence. The evidence for some of these working environment factors are examined individually. Optimizing the operating environment may have a potentially more significant impact on overall surgical outcome than improving individual surgical skill.