Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery

A nationwide analysis

Mazhar Khalil, Viraj Pandit, Peter Rhee, Narong Kulvatunyou, Tahereh Orouji, Andrew Tang, Terence OKeeffe, Lynn Gries, Gary Vercruysse, Randall S. Friese, Bellal Joseph

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: Differences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC). METHODS: National estimates for EGS procedures were abstracted from the National Inpatient Sample database. Patients undergoing emergent procedures (appendectomy, cholecystectomy, hernia repair, as well as small and large bowel resections) were included. TCs were identified based on American College of Surgeons' verification. ACS-TC programs were recorded from the American Association for the Surgery of Trauma. Outcome measures were hospital length of stay, complications, and mortality. Regression analysis was performed after adjusting for age, sex, race, Charlson comorbidity index, and type of procedure. RESULTS: A total of 131,410 patients undergoing EGS were analyzed. Patients managed in ACS-TCs had shorter hospital stay (p = 0.045) and lower complication rate (p = 0.041) compared with patients managed in both TCs and NTCs. There was no difference in mortality in patients managed across the groups; however, there was a trend toward lower mortality in patients managed in ACS-TCs in comparison with TCs (p = 0.064) and NTCs (p = 0.089). The overall hospital costs were lower for patients managed in ACS-TCs compared with TCs (p = 0.036). CONCLUSION: TCs with ACS have improved outcomes in EGS procedures compared with both TCs and non-TCs. ACS training with the associated infrastructure standards may contribute to these improved outcomes. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.

Original languageEnglish (US)
Pages (from-to)60-64
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number1
DOIs
StatePublished - Jul 3 2015
Externally publishedYes

Fingerprint

Trauma Centers
Emergencies
Length of Stay
Mortality
Appendectomy
Hospital Costs
Herniorrhaphy
Cholecystectomy
Comorbidity
Inpatients

Keywords

  • Acute care surgery model
  • emergency general surgery
  • National Inpatient Sample
  • outcomes
  • trauma centers

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery : A nationwide analysis. / Khalil, Mazhar; Pandit, Viraj; Rhee, Peter; Kulvatunyou, Narong; Orouji, Tahereh; Tang, Andrew; OKeeffe, Terence; Gries, Lynn; Vercruysse, Gary; Friese, Randall S.; Joseph, Bellal.

In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 1, 03.07.2015, p. 60-64.

Research output: Contribution to journalArticle

Khalil, M, Pandit, V, Rhee, P, Kulvatunyou, N, Orouji, T, Tang, A, OKeeffe, T, Gries, L, Vercruysse, G, Friese, RS & Joseph, B 2015, 'Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis', Journal of Trauma and Acute Care Surgery, vol. 79, no. 1, pp. 60-64. https://doi.org/10.1097/TA.0000000000000687
Khalil, Mazhar ; Pandit, Viraj ; Rhee, Peter ; Kulvatunyou, Narong ; Orouji, Tahereh ; Tang, Andrew ; OKeeffe, Terence ; Gries, Lynn ; Vercruysse, Gary ; Friese, Randall S. ; Joseph, Bellal. / Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery : A nationwide analysis. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 1. pp. 60-64.
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abstract = "BACKGROUND: Differences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC). METHODS: National estimates for EGS procedures were abstracted from the National Inpatient Sample database. Patients undergoing emergent procedures (appendectomy, cholecystectomy, hernia repair, as well as small and large bowel resections) were included. TCs were identified based on American College of Surgeons' verification. ACS-TC programs were recorded from the American Association for the Surgery of Trauma. Outcome measures were hospital length of stay, complications, and mortality. Regression analysis was performed after adjusting for age, sex, race, Charlson comorbidity index, and type of procedure. RESULTS: A total of 131,410 patients undergoing EGS were analyzed. Patients managed in ACS-TCs had shorter hospital stay (p = 0.045) and lower complication rate (p = 0.041) compared with patients managed in both TCs and NTCs. There was no difference in mortality in patients managed across the groups; however, there was a trend toward lower mortality in patients managed in ACS-TCs in comparison with TCs (p = 0.064) and NTCs (p = 0.089). The overall hospital costs were lower for patients managed in ACS-TCs compared with TCs (p = 0.036). CONCLUSION: TCs with ACS have improved outcomes in EGS procedures compared with both TCs and non-TCs. ACS training with the associated infrastructure standards may contribute to these improved outcomes. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.",
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AU - Orouji, Tahereh

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Gries, Lynn

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