Impact of an acute care surgery model on appendicectomy outcomes

Monash Medical Centre introduced the acute surgical unit (ASU) in July 2011. The ASU is modelled on the concept of acute care surgery (ACS). This study reviews the impact of the ASU on the outcomes in an appendicectomy population.

A retrospective review of all patients (aged 16-99 years) who underwent appendicectomies in the 2-year study time frame (from July 2010 to June 2012) at our centre was performed. The cohort (n = 539) was divided into two groups for analysis: the ASU group, patients admitted on or after 18 July 2011 (n = 283), and the control group, patients admitted prior to 18 July 2011 (n = 256).

Median time to operation (1129 min versus 1080 min, P = 0.963) and negative appendicectomy rate (24.2% versus 24.8%, P = 0.871) were similar in both groups. The proportion of operations performed overnight (18.00-08.00 hours) was significantly decreased in the ASU group (17.1% versus 30.7%, P < 0.001). Perforation rate was marginally higher in the ASU group (17.8% versus 11.8%, P = 0.053) but failed to reach statistical significance. There was an increase in the usage of preoperative imaging (40.3% versus 30.5%, P = 0.018) in the ASU group. Operating times, length of stay, laparoscopic-to-open conversion and surgical site infection rates remained similar.

We conclude that implementation of an ACS model does not lead to objective differences in outcome for patients after appendicectomy. However, the ACS model significantly decreased the number of operations performed after-hours.