Patient Outcomes in Laparoscopic Appendectomy With Acute Surgical Care Model Compared to Traditional Call

Introduction: Shift-based models for acute surgical care (ACS), where surgical emergencies are treated by a dedicated team of surgeons working shifts, without a concurrent elective practice, are becoming more common nationwide. We compared the outcomes for ap-pendectomy, one of the most common emergency surgical procedures, between the traditional (TRAD) call and ACS model at the same institution during the same time frame. Methods: A retrospective review of patients who underwent laparoscopic appendectomy for acute appendicitis during 2017-2018. ACS and TRAD-patient demographics, clinical pre-sentation, operative details, and outcomes were compared using independent sample t -tests, Wilcoxon rank-sum tests and Fisher's exact or c2 tests. Multiple exploratory regression models were constructed to examine the effects of confounding variables. Results: Demographics, clinical presentation, and complication rates were similar between groups except for a longer duration of symptoms prior to arrival in the TRAD group (a. = 0.5 d, P = 0.006). Time from admission to operating room (a. =-1.85 h, P = 0.003), length of hospital stay (a. =-2.0 d, P < 0.001), and total cost (a. = $-2477.02, P < 0.001) were significantly lower in the ACS group compared to the TRAD group. Furthermore, perfora-tion rates were lower in ACS (8.3% versus 28.6%, P = 0.003). Differences for the outcomes remained significant even after controlling for duration of symptoms prior to arrival (P < 0.05). Conclusions: Acute appendicitis managed using the ACS shift-based model seems to be associated with reduced time to operation, hospital stay, and overall cost, with equivalent success rates, compared to TRAD. (c) 2022 Elsevier Inc. All rights reserved.