Outcomes in emergency general surgery following the introduction of a consultant-led unit.
BACKGROUND
Patients presenting with emergency surgical conditions place significant demands on healthcare services globally. The need to improve emergency surgical care has led to establishment of consultant-led emergency surgery units. The aim of this study was to determine the effect of a changed model of service on outcomes.


METHODS
A retrospective observational study of all consecutive emergency general surgical admissions in 2009-2012 was performed. A 2-year time frame before and after the establishment of the emergency general surgery (EGS) service was used to determine the number of admissions and operations, emergency department and hospital length of stay, as well as complication rates.


RESULTS
The study included 7233 acute admissions. The EGS service managed 4468 patients (61·6 per cent increase) and performed 1804 operations (41·0 per cent increase). The most common diagnoses during the EGS period included acute appendicitis (532, 11·9 per cent), biliary disease (361, 8·1 per cent) and abdominal pain (561, 12·6 per cent). Appendicectomy (536, 29·7 per cent), cholecystectomy (239, 13·2 per cent) and laparotomy (226, 12·5 per cent) were the most commonly performed procedures. In the EGS period, time in the emergency department was reduced (from 8·0 to 6·0 h; P < 0·001), as was length of hospital stay (from 3·0 to 2·0 days; P < 0·001). The number of complications was reduced by 46·8 per cent, from 172 (6·2 per cent) to 147 (3·3 per cent) (P < 0·001), with a 53 per cent reduction in the number of deaths in the EGS period, from 29 (16·9 per cent) to seven (8 per cent) (P = 0·039).


CONCLUSIONS
The establishment of a consultant-led emergency surgical service has been associated with improved provision of care, resulting in timely management and improved clinical outcomes.
Department of General Surgical Specialties, University of Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Victoria, Australia.
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Shakerian
Department of General Surgical Specialties, University of Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Victoria, Australia.
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Thomson
Melbourne EpiCentre, Centre for Clinical Epidemiology, Biostatistics and Health Services Research, (University of Melbourne and Melbourne Health), The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Gorelik
Department of General Surgical Specialties, University of Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Victoria, Australia.
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Hayes
Department of General Surgical Specialties, University of Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Victoria, Australia.
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Skandarajah
D015746:Abdominal Pain / Q000601:surgery*; D003253:Consultants; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative