Redefining acute care surgery

Peitzman, Andrew B.; Sperry, Jason L.; Kutcher, Matthew; Zuckerbraun, Brian S.; Forsythe, Raquel M.; Billiar, Timothy R.; Alarcon, Louis H.; Rosengart, Matthew R.; Watson, Gregory A.; Puyana, Juan Carlos; Bauzá, Graciela; Schuchert, Vaishali D.; Neal, Matthew D.

doi:10.1097/ta.0000000000000717

Cited by 24 publications

(14 citation statements)

References 5 publications

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“…Most cases of bleeding control (6.7% of all surgical cases) were caused by blunt traumatic event. surgery and elective surgery [11]. In 2012, a survey was conducted to examine the opinions of general surgical residents in the U.S. regarding training and careers in ACS.…”

Section: Resultsmentioning

confidence: 99%

10 Years of Acute Care Surgery: Experiences in a Single Tertiary University Hospital in Korea

Kim

Park²,

Jung

et al. 2020

J Acute Care Surg

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The novel concept of acute care surgery (ACS) was initially proposed by the American Association for the Surgery of Trauma in 2005. The emerging specialty was composed of trauma, surgical critical care, and emergency general surgery [1]. Several factors have been proposed as contributing to the emergence of ACS in the U.S.; a national shortage of general surgeons [2], decreased interest in trauma or surgical critical care as a career option [3], and a medical blind spot of nontrauma patients who required emergency surgical treatment. ACS has been successfully adopted in many U.S. medical centers and has improved patient outcomes and treatment efficiency [4-8]. Patients who needed emergency surgical care traditionally had to wait for the general surgeon on-call, who was usually working in outpatient departments or performing elective surgery; In this traditional model, a blind spot was evident for surgical treatment of non-trauma patients before ACS was adopted [5]. This lack of prompt availability of the general surgeon for patients who needed emergency general surgery, delayed surgical evaluation, and treatment for these critically ill patients. Trauma and surgical critical care as a specialty is not

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Section: Resultsmentioning

confidence: 99%

10 Years of Acute Care Surgery: Experiences in a Single Tertiary University Hospital in Korea

Kim

Park²,

Jung

et al. 2020

J Acute Care Surg

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“…Indeed, a recent opinion piece in the Journal of Trauma and Acute Care Surgery suggested that Acute Care Surgery should be redefined to include the essential component of ‘surgical rescue’ (19). Though there may be little disagreement among trauma and acute care providers that the rescuing patients from adverse events after injury is a critical part of our mission, there has been little critical thinking about how these efforts should be measured.…”

Section: Discussionmentioning

confidence: 99%

A metric of our own

Holena

Kaufman

Delgado

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Failure to rescue (FTR) is defined as death after an adverse event. The original metric was derived in elective surgical populations and reclassifies deaths not preceded by recorded adverse events as FTR cases under the assumption these deaths resulted from missed adverse events. This approach lacks face validity in trauma because patients often die without adverse events as a direct result of injury. Another common approach simply excludes deaths without recorded adverse events, but this approach reduces the reliability of the FTR metric. We hypothesized that a hybrid metric excluding expected deaths but otherwise including patients without recorded adverse events in FTR analysis would improve face validity and reliability relative to existing methods. Methods Using 3 years of single-state adult trauma registry data from 30 trauma centers, we constructed 3 FTR metrics: 1.) Excluding deaths not preceded by adverse events (FTR-E), 2.) Reclassifying deaths not preceded by adverse events (FTR-R), and 2.) Including deaths not preceded by adverse events in FTR analysis except those with predicted mortality >50% (FTR-T). Mortality, adverse event, and FTR rates were calculated under each method, and reliability was tested using Spearman’s correlation for split-sample center rankings. Results A total of 89,780 patients were included (median age 57 (IQR 26–73), 85% Caucasian, 59% male, 92% blunt, median ISS 9 (IQR5–14)). FTR rates varied by metric (FTR-E: 11.2%; FTR-R 31.2%; FTR-T 21.4%)), as did the proportion of deaths preceded by adverse events (FTR-E 28%; FTR-R: 100%; FTR-T: 60%). Spit-sample reliability was higher FTR-T than FTR-E (rho=0.59 vs) (rho=0.27, p<0.001). Conclusions A trauma-specific FTR metric increases face validity and reliability relative to other FTR methods which may be employed in trauma populations. Future trauma outcomes studies examining FTR rates should use a metric designed for this cohort. Level of Evidence Level III

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“…17–22 The skills of the acute care surgeon are uniquely tailored to the time-sensitive physiology of such patients, and are particularly critical in maintaining institution-wide patient outcomes in centers with active interventional and surgical specialty services. 23, 24…”

Section: Introductionmentioning

confidence: 99%