Comparative analysis of emergency general surgery on‐call structure and its impact on emergency appendicectomy outcomes

Abstract

Background In Australia, there has been a shift from the traditional ‘on‐call’ surgical model to the ‘acute surgical unit’ (ASU) model to improve outcomes in acute general surgery. Using emergency appendicectomy as a standardized procedure, we aimed to identify the different patterns of care between these on‐call structures by comparing two metropolitan district hospitals; one that employs a traditional on‐call model and the other, which employ the ASU model. Methods Data on consecutive patients undergoing emergency appendectomies at the two hospitals (traditional and ASU model) between July 2018 and December 2018 were retrieved for retrospective review. Patient factors, preoperative factors, operative factors and post‐operative outcomes were collected and tabulated for comparative analysis between the traditional versus ASU model of care. Results Univariate analysis demonstrated that there were a greater proportion of consultant‐led cases (P < 0.001), a shorter time to theatre (P = 0.047) and a greater number of out‐of‐hours operations (P < 0.001) in the ASU model compared to the traditional model. A larger proportion of patients from the traditional model underwent a computed tomography scan as part of their diagnostic workup compared to the ASU model (P < 0.001). There was no difference in negative appendicectomy rates, intraoperative conversion rates, post‐operative complication rates or mean lengths of hospital stay between the two on‐call models. Conclusion The ASU and traditional on‐call model appears to achieve equivalent care outcomes for patients with acute appendicitis.

The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

“…A greater consultant presence also likely contributed to this more efficient patient journey, with the majority of patients who presented via the ASAU having a same-day review by the most senior surgeon on call. Similar observations of improved patient flow have been made in ASAUs in both Australia and New Zealand, where emergency services that are separate from elective commitments have led to a more prompt time to theatre [12,18,19]. Shorter waiting times are of little value if they are not accompanied by improved clinical outcomes.…”