Description of the MIS EGS surgeon phenotype: how disruptive innovation can push the envelope of EGS practice

The structure of care for Emergency General Surgery (EGS) practices varies widely across hospital settings. EGS practices outside the setting of acute care surgery (ACS) services are less well understood. Within a multi-hospital setting, an innovative MIS-focused EGS practice was created to improve surgeon satisfaction, patient outcomes, and patient retention. We report successful implementation and expansion of an MIS EGS service across three hospital settings.

Retrospective analysis of cases between January 2023 and December 2025 by a group of EGS surgeons across three hospitals using data available from the electronic medical record. Clinic volumes were identified for 2024/2025. Information on case volumes and types (elective vs. non-elective status, case type, OR block time) and clinic volumes and type of clinic visits were reported.

Over the 36-month period, 10,228 surgical cases were performed, the majority non-elective. A total of 8.4 FTE surgeons staffed three hospital EGS services, a total of four surgeons with clinical responsibilities Monday-Friday and two surgeons with clinical responsibilities on nights and weekends. Half-day clinics were staffed by surgeons for a total of 3.5 days per week across two sites with > 5000 clinic visits per year. 17.2% of elective cases had an ED visit within 8 weeks prior to their surgical intervention, with the most common diagnoses being biliary, gastrointestinal, and hernia related.

Inclusion of elective cases within an EGS practice is feasible. Giving patients who present to the ED expedited follow-up and converting their surgical management to outpatient elective cases has many potential benefits. We believe this type of care model can allow for effective block utilization, efficient patient care, and surgeon satisfaction. Outlining the utility of a combination EGS + elective group practice for the hospital, patients, and surgeons can provide support for ongoing expansion of EGS focus outside of trauma settings.