Beyond just the operating room: characterizing the complete caseload of a tertiary acute care surgery service

Zyl, Theunis Jean Van; Murphy, Patrick; Allen, Laura; Parry, Neil; Leslie, Ken; Vogt, Kelly

doi:10.1503/cjs.007417

Cited by 10 publications

(12 citation statements)

References 33 publications

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“…The complete caseload of ACS services extends beyond these 2 common presentations, however, and therefore studies examining the other patients managed by EGS surgeons are essential to provide a framework for understanding the epidemiology, morbidity and mortality associated with nonbiliary, nonappendiceal conditions. [8][9][10] These studies demonstrate operative rates in admitted patients ranging from 25% to 88%. 3,[8][9][10] In all series, the most frequently performed operations are appendectomy and cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] These studies demonstrate operative rates in admitted patients ranging from 25% to 88%. 3,[8][9][10] In all series, the most frequently performed operations are appendectomy and cholecystectomy. Similar to our results, however, the remainder of the cases can be categorized as hernia repairs, bowel resections for benign and malignant disease, and drainage of skin and soft tissue infections.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of complex emergency general surgery in Canada

Vogt

Allen

Murphy

et al. 2020

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Patterns of complex emergency general surgery in Canada Background: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada. Methods: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged ≥ 18 yr) undergoing nonelective operative interventions for nonbiliary, non appendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality. Results: A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11%) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and débridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall inhospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age (p = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre (p = 0.001). Conclusion: This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement. Contexte : La plupart des études sur les services de chirurgie générale d'urgence (CGU) s'intéressent seulement aux atteintes de l'appendice et de la vésicule biliaire. Pourtant, les chirurgiens du domaine traitent beaucoup d'autres problèmes complexes. L'objectif de l'étude était de décrire le travail chirurgical associé à ces problèmes dans l'ensemble du Canada. Méthodes : Notre étude de cohorte rétrospective multicentrique inclut les patients adultes (≥ 18 ans) qui ont subi en 2014 une opération non planifiée pour une atteinte qui ne touchait ni l'appendice ni la vésicule biliaire dans 1 des 7 centres sélectionnés, répartis un peu partout au pays. Nous avons recueilli les données suivantes : renseignements de base des patients, diagnostic, détails de l'intervention, nature des complications et durée d'hospitalisation. Puis nous avons dégagé les facteurs prédictifs de morbidité et de mortalité en appliquant un modèle de régression logistique. Résultats : L'échantillon totalisait 2595 patients, pour un âge médian de 60 ans (écart interquartile 46-73 ans). Les diagnostics principaux les plus ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of complex emergency general surgery in Canada

Vogt

Allen

Murphy

et al. 2020

cjs

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“…Where dedicated EGS teams are provided access to daytime OR resources, the ACS model has the potential to address this issue. 35 A recent meta-analysis by Murphy and colleagues found that the benefits of the ACS model are dependent on access to dedicated daytime OR resources. 9 Unfortunately, this remains a major challenge for most Canadian institutions.…”

Section: Discussionmentioning

confidence: 99%

“… 42 Although comparative Canadian data are lacking, data from the ACS service in London, Ontario, indicated an average case volume of 14 cases per week, although logs of actual resident-attended operations were not reported. 35 Resident case log data from American training programs indicated that residents attended approximately 9 cases per week. 19 Overall, the case volume reported by McMaster University general surgery residents is low, which raises concerns about the adequacy of their exposure to EGS operations while they are on ACS rotations.…”

Section: Discussionmentioning

confidence: 99%

Impact of the acute care surgery model on resident operative experience in emergency general surgery

Meschino

Giles

Engels

et al. 2021

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Background: The acute care surgery (ACS) model has been shown to improve patient, hospital and surgeon-specific outcomes. To date, however, little has been published on its impact on residency training. Our study compared the emergency general surgery (EGS) operative experiences of residents assigned to ACS versus elective surgical rotations. Methods: Resident-reported EGS case logs were prospectively collected over a 9-month period across 3 teaching hospitals. Descriptive statistics were tabulated and group comparisons were made using χ2 statistics for categorical data and t tests for continuous data. Results: Overall, 1061 cases were reported. Resident participation exceeded 90%). Appendiceal and biliary disease accounted for 49.7% of EGS cases. Residents on ACS rotations reported participating in twice as many EGS cases per block as residents on elective rotations (12.64 v. 6.30 cases, p < 0.01). Most cases occurred after hours while residents were on call rather than during daytime ACS hours (78.8% v. 21.1%, p < 0.01). Senior residents were more likely than junior residents to report having a primary operator role (71.3% v. 32.0%, p < 0.01). Although the timing of cases made no difference in the operative role of senior residents, junior residents assumed the primary operator role more often during the daytime than after hours (50.0% v. 33.1%, p = 0.01). Conclusion: Despite implementation of the ACS model, residents in our program obtained most of their EGS operative experience after hours while on call. Although further research is needed, our study suggests that improved daytime access to the operating room may represent an opportunity to improve the quantity and quality of the EGS operative experience at our academic network.

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“…Much of this work is being championed by the Canadian Collaborative on Urgent Care Surgery (CANUCS). 15,23,[29][30][31] Direction for future studies, particu larly at centres introducing physician extenders on their ACS service (PAs, NPs, hospitalists), include objective assessment of the impact on ACS service efficiency and costeffectiveness, patient outcomes, emergency depart ment disposition times, resident learning, and satisfaction scores for residents, staff and allied health team members. These outcomes should be tracked and collected by a research team member rather than the already overbur dened ACS team members (PA, residents, etc.…”

Section: Discussionmentioning

confidence: 99%

The emergence of the physician assistant role in a Canadian acute care surgery setting

Lack

Saddik

Engels

et al. 2020

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The emergence of the physician assistant role in a Canadian acute care surgery setting Background: The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the con tribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. Methods: To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multi disciplinary meetings were prospectively collected. We report data for 365 consecu tive days from Dec. 30, 2016, to Dec. 29, 2017. Results: The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. Conclusion: Integrating a PA on an ACS team adds value to patient care by provid ing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consul tations and effective organization of the ACS team members. Contexte : Les adjoints au médecin (AM) jouent un rôle croissant dans les soins chirur gicaux au Canada. Suivant la même tendance, le modèle de chirurgie en soins actifs (CSA) poursuit son évolution, et on considère de plus en plus les AM comme des membres des équipes de CSA. Cependant, les retombées de leur travail et leur contri bution ont été peu étudiées, et de façon imprécise. Notre étude décrit la contribution d'un AM travaillant à temps plein, en semaine, au sein d'une équipe de CSA dans un centre hospitalier universitaire canadien de soins tertiaires. Méthodes : Afin de quantifier la contribution de l'AM, nous avons créé une base de données de CSA en septembre 2016. Nous avons collecté les données-nombre de rencontres avec des patients, de consultations et d'admissions de l'équipe; partici pation de l'AM au bloc opératoire; nombre de rencontres de l'AM avec des patients; nombre de réunions multidisciplinaires-de manière prospective. Nos données décrivent une période de 365 jours consécutifs, qui s'étale du 30 décembre 2016 au 29 décembre 2017. Résultats : L'équipe de CSA a tenu 11 651 rencontres avec des patients dans l'année, pour une moyenne de 31,92 par jour. En moyenne, elle a réalisé 5,89 consultations et...

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Beyond just the operating room: characterizing the complete caseload of a tertiary acute care surgery service

Abstract: Acute care surgery teams care for a wide breadth of disease, a considerable amount of which is managed nonoperatively.

Cited by 10 publications

References 33 publications

Patterns of complex emergency general surgery in Canada

Patterns of complex emergency general surgery in Canada

Impact of the acute care surgery model on resident operative experience in emergency general surgery

The emergence of the physician assistant role in a Canadian acute care surgery setting

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