title: Old dogs and new tricks: length of stay for appendicitis improves with an acute care surgery program and transition from private surgical practice to multispecialty group practice.
abstract: Acute care surgery (ACS) programs have emerged mainly at academic medical centers to provide timely care for emergency general surgery and trauma patients. We hypothesized that the development of an ACS program in a multispecialty group practice would improve outcomes for patients with acute appendicitis. A retrospective analysis of patients with acute appendicitis was performed in two time periods: 18 months of private practice and the following 12 months with ACS coverage. Length of stay was the primary outcome measure. A total of 871 patients were studied (526 private practice, 345 ACS). The ACS group had a greater proportion of laparoscopic appendectomies (P < 0.001) and more transitions in care between surgeons (P < 0.001). Length of stay was shorter in the ACS group (1.6 ± 1.5 [mean ± standard deviation] vs 1.9 ± 2.4 days, P = 0.01) and a greater proportion of surgeries were performed during the daytime (44.9 vs 36.6%, P = 0.02). Multivariate analysis demonstrated length of stay was related to appendicitis grade (P < 0.001), American Society of Anesthesiologists class (P < 0.001), symptom duration (P = 0.001), and laparoscopic approach (P < 0.001). The initial transition from private practice to ACS resulted in decreased length of stay with no increase in morbidity related to transitions of surgical care in patients with appendicitis.
authors.affiliation: GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan, USA.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.forename: Amie M
authors.initials: AM
authors.lastname: Ecker
authors.forename: David J
authors.initials: DJ
authors.lastname: Hobbs
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Wilkes
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hagelberg
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Rodriguez
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Scholten
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006123:Group Practice / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011331:Private Practice / Q000458:organization & administration*; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult