title: Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost.
abstract: BACKGROUND
  The acute care surgery model is a novel notion in the provision of emergency general surgery. To date, several studies have analyzed the effects on patient health outcomes and timeliness of care for nontrauma patients within the scope of acute general surgery and emergencies, but none have assessed the cost benefits of this model.
  
  
  METHODS
  A retrospective analysis of patients undergoing appendectomy or cholecystectomy in the setting of acute abdomen was performed to compare data from 2 cohorts, the traditional model from July 2009 to June 2010 and the acute care surgery model from July 2010 to June 2011. Categorical variables and comparison means were examined using chi-square and independent 2-tailed sample t-tests.
  
  
  RESULTS
  One hundred and seventy-five patients underwent appendectomy and 113 underwent cholecystectomy. The traditional model team staffed 82 appendectomies and 51 cholecystectomies, and the acute care surgery team staffed 93 and 62, respectively. In the appendectomy group, there was a statistically significant mean reduction of time to surgical evaluation (2.19 hours; p < 0.001) and time to the operating room (5.38 hours, p = 0.006), there were 7 fewer patients with complications (p = 0.06) and a reduced length of stay (1 day, p = 0.002) for the acute care surgery cohort. Similar statistically significant differences were observed in the cholecystectomy group in the acute care surgery cohort: surgical evaluation difference = 5.84 hours (p = 0.03), time to operating room difference = 25.37 hours (p = 0.002), 8 fewer patients with complications (p = 0.01), and length of stay difference was 2 days (p = 0.03) compared with the traditional model cohort.
  
  
  CONCLUSIONS
  The newly implemented acute care surgery model in our institution accomplished earlier treatment and shorter length of stay for the 2 most common causes of acute abdomen in our setting. Overall, the new model translated to better outcomes for patients and savings per case for the hospital.
authors.affiliation: Department of Surgery, Loma Linda University, Loma Linda, CA 92350, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cubas
authors.forename: Nephtali R
authors.initials: NR
authors.lastname: Gómez
authors.forename: Samuel
authors.initials: S
authors.lastname: Rodriguez
authors.forename: Morcos
authors.initials: M
authors.lastname: Wanis
authors.forename: Arun
authors.initials: A
authors.lastname: Sivanandam
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Garberoglio
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000328:Adult; D001062:Appendectomy / Q000191:economics / Q000592:standards; D001064:Appendicitis / Q000150:complications / Q000191:economics / Q000601:surgery*; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000191:economics / Q000592:standards; D041881:Cholecystitis, Acute / Q000150:complications / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors; D016896:Treatment Outcome