Establishing an acute care surgery service: lessons learned from the epidemiology of emergent non-trauma patients and increasing utilization of laparoscopy.

BACKGROUND

Acute care surgery is a fellowship training model created to address the growing crisis in emergency healthcare due to decreased availability of on-call surgeons and reduction in operative procedures for trauma. Our objective was to identify the demographics and spectrum of diseases in patients presenting with non-trauma surgical emergencies and the use of laparoscopy in emergent surgery in light of implementing an acute care surgery model.

METHODS

All non-trauma emergency surgical consultations at a large urban academic medical center from January 2005 to December 2008 were retrospectively reviewed. A clinician-completed registry was used to obtain patient information. Diagnoses were categorized into five broad groups for statistical analysis.

RESULTS

Median age was 41 years (range, 6 weeks to 97 years), 50% were men, and the majority (67%) was Hispanic. The most common disease category was infectious followed by hepatobiliary. Prevalence of disease categories differed significantly among various racial groups. Majority (86%) of consult patients required admission. Thirty-eight percent of the consults resulted in an operative procedure, 40% of which were laparoscopic. The percentage of laparoscopic procedures increased during the 4-year study period.

CONCLUSION

Patients with non-trauma surgical emergencies are young with a significantly wide range of diseases based on race. Less than half require emergent surgery. Laparoscopy is prevalent in emergency surgery and growing. Resources should be allocated to maximize the ability to treat infectious and hepatobiliary diseases, and to increase utilization of laparoscopy. The acute care surgeon needs to be proficient in laparoscopy.