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Acute Care Surgery Model: High Quality Care for Higher Risk Populations.

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Area of Science:

  • Surgical outcomes
  • Health services research
  • Health equity

Background:

  • Emergency General Surgery (EGS) is associated with high complication and mortality rates.
  • Factors like race, insurance, and socioeconomic status impact EGS patient outcomes.
  • Acute Care Surgery (ACS) models have demonstrated improved results in EGS.

Purpose of the Study:

  • To evaluate the impact of transitioning to an ACS model on access to care for underserved and higher-risk EGS patients.
  • To determine if the ACS model changed mortality rates in EGS patients at a community hospital.

Main Methods:

  • Retrospective cohort study of adult EGS patients (2017-2021) undergoing specific procedures.
  • Analysis of patients before (pre-ACS) and after (post-ACS) a hospital-wide ACS model transition in July 2020.
  • Primary outcome: mortality; Secondary outcomes: 30-day postoperative emergency department visits and readmissions.

Main Results:

  • Post-ACS transition, patients were more likely to be Black, older, self-pay, and have higher Elixhauser Comorbidity Index (ECI) scores.
  • No significant change in 30-day all-cause mortality or postoperative emergency department visits.
  • Significant increase in hospital readmissions observed after the ACS transition (5.1% vs. 10.5%).

Conclusions:

  • ACS model implementation increased access for older, Black, underinsured patients with higher comorbidity.
  • Mortality rates remained unchanged, suggesting quality of care was maintained.
  • ACS models in community hospitals may enhance access to quality EGS care for vulnerable populations.