title: Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis.
abstract: BACKGROUND
  Differences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC).
  
  
  METHODS
  National estimates for EGS procedures were abstracted from the National Inpatient Sample database. Patients undergoing emergent procedures (appendectomy, cholecystectomy, hernia repair, as well as small and large bowel resections) were included. TCs were identified based on American College of Surgeons' verification. ACS-TC programs were recorded from the American Association for the Surgery of Trauma. Outcome measures were hospital length of stay, complications, and mortality. Regression analysis was performed after adjusting for age, sex, race, Charlson comorbidity index, and type of procedure.
  
  
  RESULTS
  A total of 131,410 patients undergoing EGS were analyzed. Patients managed in ACS-TCs had shorter hospital stay (p = 0.045) and lower complication rate (p = 0.041) compared with patients managed in both TCs and NTCs. There was no difference in mortality in patients managed across the groups; however, there was a trend toward lower mortality in patients managed in ACS-TCs in comparison with TCs (p = 0.064) and NTCs (p = 0.089). The overall hospital costs were lower for patients managed in ACS-TCs compared with TCs (p = 0.036).
  
  
  CONCLUSIONS
  TCs with ACS have improved outcomes in EGS procedures compared with both TCs and non-TCs. ACS training with the associated infrastructure standards may contribute to these improved outcomes.
  
  
  METHODS
  Therapeutic/care management study, level IV.
authors.affiliation: From the Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, The University of Arizona, Tucson, Arizona.
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Tahereh
authors.initials: T
authors.lastname: Orouji
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data