title: Beyond emergency surgery: redefining acute care surgery.
abstract: BACKGROUND
  Considerable debate exists regarding the definition, skill set, and training requirements for the new specialty of acute care surgery (ACS). We hypothesized that a patient subset could be identified that requires a level of care beyond general surgical training and justifies creation of this new specialty.
  
  
  METHODS
  Reviewed patient admissions over 1-y to the only general surgical service at a level I trauma center-staffed by trauma and/or critical care trained physicians. Patients classified as follows: trauma, ACS, emergency general (EGS), or elective surgery. ACS patients are nonelective, nontrauma patients with significantly altered physiology requiring intensive care unit admission and/or specific complex operative interventions. Differences in demographics, hospital course, and outcomes were analyzed.
  
  
  RESULTS
  In-patient service evaluated approximately 5500 patients, including 3300 trauma patients. A total of 2152 admissions include 37% trauma, 30% elective, 28% EGS, and 4% ACS. ACS and trauma patients were more likely to require multiple operations (ACS relative risk [RR] = 11.5; trauma RR = 5.7, P < 0.0001), have longer hospital and intensive care unit length of stay, and higher mortality (P < 0.0001). They were less likely to be discharged home (ACS RR = 0.75; trauma RR = 0.67, P < 0.0001) compared with that of the EGS group. EGS and elective patients were most similar to each other in multiple areas.
  
  
  CONCLUSIONS
  ACS and EGS patients represent distinct patient cohorts, as reflected by significant differences in critical care needs, likelihood of multiple operations, and need for postdischarge rehabilitation. The skills required to care for ACS patients, including ability to rescue from complications and provide critical care, differ from those required for EGS patients and supports development of ACS training and regionalization of care.
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: Alicia R
authors: AR
authors: Privette
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: Abigail E
authors: AE
authors: Evans
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: Jarrett C
authors: JC
authors: Moyer
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: Mary F
authors: MF
authors: Nelson
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: M Margaret
authors: MM
authors: Knudson
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: Robert C
authors: RC
authors: Mackersie
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California.
authors: Rachael A
authors: RA
authors: Callcut
authors: Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, California. Electronic address: MCohen@sfghsurg.ucsf.edu.
authors: Mitchell J
authors: MJ
authors: Cohen
mesh_terms: D000328:Adult; D003422:Critical Care; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Acute care surgery; Emergency general surgery