Browsing by Author "Kortbeek, John Barry"

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    Acute Care Surgery Outcomes
    (2019-05-15) Al-Busaidi, Omar Mohammed; Kortbeek, John Barry; Ball, Chad Geoffrey G.; Stelfox, Henry Thomas; Austen, Lea; Turin, Tanvir Chowdhury
    Introduction: The acute care surgery (ACS) model was initiated two decades ago to address issues of availability, timeliness and quality in emergency general surgery care. Previous publications were retrospective, single centred and lacked specific information about morbidity and mortality rates of common ACS procedures. Given that ACS is an evolving model and that the full impact of its implementation is not yet fully understood, we studied the effect of ACS implementation on morbidity and mortality. Methods: Part I, a systematic review and meta-analysis of outcome studies of appendectomies and cholecystectomies before and after the implementation of ACS. Part II, a prospective analysis of ACS post-operative morbidities and mortality in 8 high-volume centres (excluding trauma) was performed. The evaluation was conducted over a 30-day period. Results: In part I, of 1704 studies, 27 studies were selected for analysis. Following ACS introduction, the overall complication rate was significantly reduced in both appendectomy and cholecystectomy (Risk ratios = 0.7; 95% CI 0.57 to 0.85 and RR=0.6; 95% CI 0.40 to 0.94) respectively. Length of stay and time to operate were significantly reduced in both groups. In part II, there were a total of 601 post-operative patients who were followed for up to a period of 30 days. Of those, 66% of the procedures were laparoscopic. The overall complication rate was 34% and mortality was 2%. In open procedures, the morbidity rate was 73%. Conclusions: The implementation of the ACS model was associated with a significant reduction in morbidity and mortality in patients’ with appendicitis and cholecystitis. ACS patients continue to represent a high-risk population. Appropriate hospital and system resources are essential for successful implementation of the ACS model. Keywords: Acute care surgery, ACS, appendectomy, cholecystectomy. Morbidity