title: Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.
abstract: BACKGROUND
  The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes.
  
  
  METHODS
  A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality.
  
  
  RESULTS
  Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02).
  
  
  CONCLUSIONS
  The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change.
authors.affiliation: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. anton.musiienko@mh.org.au.
authors.forename: Anton M
authors.initials: AM
authors.lastname: Musiienko
authors.affiliation: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Rose
authors.initials: R
authors.lastname: Shakerian
authors.affiliation: The Melbourne EpiCentre, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Benjamin N J
authors.initials: BN
authors.lastname: Thomson
authors.affiliation: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Skandarajah
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D016896:Treatment Outcome; D014739:Victoria
keywords: diagnostic imaging; emergency service; general surgery; intestinal obstruction; time-to-treatment