title: Does regionalization of acute care surgery decrease mortality?
abstract: BACKGROUND
  During the initial development of an Emergency General Surgery (EGS) service, severity of illness (SOI) can be expected to be high and should decrease as the service matures. We hypothesize that a matured regional EGS service would show decreasing mortality and length of stay (LOS) over time.
  
  
  METHODS
  We performed a retrospective study of a prospectively collected EGS registry data from 2004 to 2009. Patients were included if they had been discharged from the EGS service and were stratified by year of discharge. Systemic inflammatory response syndrome, sepsis, shock, peritonitis, perforation, and acute renal failure were used as markers of SOI. Patients were defined as high acuity if they had one or more of these SOI markers. Differences in mortality, LOS, intensive care unit admissions, SOI, charges, and distance were compared across and between years using nonparametric statistical tests (Fisher's exact, Wilcoxon rank-sum, and Kruskal-Wallis tests).
  
  
  RESULTS
  A total of 3,439 patients met study criteria. The mean age was 47 years ± 17.5 years. The majority of the patients were female (1,813, 47.3%). The overall LOS was 6.4 days ± 9.4 days (median, 4 days). In all, 2,331 (67.8%) of the patients underwent operation. Over the course of the study period, the SOI indicators stabilized at between 13% and 17% of the patient population with at least one indicator. During that time period, mortality steadily decreased from 4.9% to 1.3% (p < 0.5).
  
  
  CONCLUSIONS
  Despite consistently high SOI, a dedicated and matured EGS service demonstrated a decrease in mortality and LOS.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA. jose.diaz@vanderbilt.edu
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Norris
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Gunter
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Collier
authors.forename: William P
authors.initials: WP
authors.lastname: Riordan
authors.forename: John A
authors.initials: JA
authors.lastname: Morris
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D013502:General Surgery / Q000458:organization & administration; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D014194:Traumatology / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality*