title: Management of acute appendicitis by an acute care surgery service: is operative intervention timely?
abstract: BACKGROUND
  Trauma services are increasingly providing emergency surgery care by creating "acute care surgery" teams. We compared two periods at a Level I trauma center to determine if trauma service coverage would negatively impact timely management of acute appendicitis.
  
  
  METHODS
  All patients admitted through the emergency department of a Level I trauma center who underwent appendectomies between March 2005 and May 2006 (Trauma period) were identified. During this period, the trauma service covered most surgical emergencies. Comparison was made with the earlier 15-month period (Pretrauma). Emergency department to operating room (OR) time, procedure length, and negative appendectomy rates were obtained.
  
  
  RESULTS
  In the Pretrauma period, 273 patients underwent appendectomy, compared with 279 in the Trauma period. Two-thirds (66%) of appendectomies in the Trauma period were performed by trauma surgeons. There was no difference in both periods with regard to mean emergency department to OR time (10.5 hours versus 9.9 hours; p = 0.4509), perforation rates (12% Pretrauma versus 7.5% Trauma; p = 0.1134), or negative appendectomy rates (17.9% Pretrauma versus 18.2% Trauma; p = 1.0). In the Trauma period, more appendectomies were completed laparoscopically (84.6% Trauma versus 66.6% Pretrauma; p < 0.0001), and mean OR time was shorter (57.4 minutes versus 67 minutes; p = 0.0006).
  
  
  CONCLUSIONS
  In comparing two periods with and without the trauma service coverage of surgical emergencies, no difference was found in emergency department to OR time, perforation rates, or negative appendectomy rates in the management of acute appendicitis. There was a decrease in operative time and an increase in the proportion of laparoscopic appendectomies in the Trauma period. Trauma services can effectively incorporate emergency surgical coverage of procedures, such as appendectomies, without compromising timely intervention.
authors.affiliation: Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH 45459, USA. peter.ekeh@wright.edu
authors.forename: Akpofure Peter
authors.initials: AP
authors.lastname: Ekeh
authors.forename: Benjamin
authors.initials: B
authors.lastname: Monson
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wozniak
authors.forename: Matthew
authors.initials: M
authors.lastname: Armstrong
authors.forename: Mary C
authors.initials: MC
authors.lastname: McCarthy
mesh_terms: D000208:Acute Disease; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D013997:Time Factors