title: The impact of acute care surgery on appendicitis outcomes: Results from a national sample of university-affiliated hospitals.
abstract: BACKGROUND
  Acute appendicitis is the most common indication for emergency general surgery (EGS) in the United States. We examined the role of acute care surgery (ACS) on interventions and outcomes for acute appendicitis at a national sample of university-affiliated hospitals.
  
  
  METHODS
  We surveyed senior surgeons responsible for EGS coverage at University HealthSystems Consortium hospitals, representing more than 90% of university-affiliated hospitals in the United States. The survey elicited data on resources allocated for EGS during 2013. Responses were linked to University HealthSystems Consortium outcomes data by unique hospital identifiers. Patients treated at hospitals reporting hybrid models for EGS coverage were excluded. Differences in interventions and outcomes between patients with acute appendicitis treated at ACS hospitals versus hospitals with a general surgeon on-call model (GSOC) were analyzed using univariate comparisons and multivariable logistic regression models adjusted for patient demographics, clinical acuity, and hospital characteristics.
  
  
  RESULTS
  We found 122 hospitals meeting criteria for analysis where 2,565 patients were treated for acute appendicitis. Forty-eight percent of hospitals had an ACS model (n = 1,414), and 52% had a GSOC model (n = 1,151). Hospitals with ACS models were more likely to treat minority patients than those with GSOC models. Patients treated at ACS hospitals were more likely to undergo laparoscopic appendectomy. In multivariable modeling of patients who had surgery (n = 2,258), patients treated at ACS hospitals had 1.86 (95% confidence interval, 1.23-2.80) greater odds of undergoing laparoscopic appendectomy.
  
  
  CONCLUSIONS
  In an era when laparoscopic appendectomy is increasingly accepted for treating uncomplicated acute appendicitis, particularly in low-risk patients, it is concerning that patients treated at GSOC model hospitals are more likely to undergo traditional open surgery at the time of presentation. Furthermore, hospitals with ACS are functioning as safety-net hospitals for vulnerable patients with acute appendicitis.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: From the Department of Surgery (J.C.M., C.E.C., M.D.A., H.P.S.), and Surgery and Department of Quantitative Health Sciences (D.A., H.P.S.), University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: John C
authors.initials: JC
authors.lastname: Madore
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Collins
authors.forename: M Didem
authors.initials: MD
authors.lastname: Ayturk
authors.forename: Heena P
authors.initials: HP
authors.lastname: Santry
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D019538:Health Care Surveys; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult