Goh Serene Si Ning, Cheok Sabrina Hui Xian, Lim Woan Wui, Tan Kok Yang, Goo Tiong Thye
Department of General Surgery Khoo Teck Puat Hospital Singapore Singapore.
Acute Med Surg. 2020 Jun 3;7(1):e523. doi: 10.1002/ams2.523. eCollection 2020 Jan-Dec.
The Emergency Surgery and Trauma (ESAT) team is a dedicated consultant-led service to streamline the emergency surgical workload in Singapore. As acute appendicitis is one of the most common acute surgical conditions, we aim to compare outcomes of patients with appendicitis in the ESAT model as compared to the traditional on-call model.
A retrospective review of patients admitted to Khoo Teck Puat Hospital, Singapore, with acute appendicitis between two periods: May-October 2014 (6 months pre-ESAT) versus January-June 2017 (post-ESAT). Patient demographics, operative details, efficiency, clinical outcomes, and hospital bill savings were evaluated.
There were 192 patients in the pre-ESAT period and 179 patients in the post-ESAT period. Patient demographics and comorbidities were comparable (> 0.05). Time from emergency department referral to surgical review was significantly reduced in the ESAT period: 77.8 ± 46.9 min versus 127 ± 102 in the pre-ESAT period ( = 0.002). Time from case booking to operating theatre was significantly shorter in the ESAT period: 72.4 ± 55.2 min compared to 157.3 ± 209.1 ( < 0.01). More cases were carried out in the daytime during the ESAT period, 50.2% versus 39.1% ( = 0.029). The majority underwent laparoscopic appendectomy 156/179 (87.2%) in the ESAT period, with fewer open appendectomies 3/179 (1.7%) as compared to the pre-ESAT period ( = 0.062). There were higher intraoperative consultant supervision rates during the ESAT period, 38/166 (22.9%) as compared to 12/166 (6.7%) in the pre-ESAT period ( = 0.001). There were fewer complications (Clavien-Dindo grade II and above) in the ESAT period, 1 (0.6%) as compared to 6 (3.4%) pre-ESAT ( = 0.07).
The ESAT service is associated with better efficiency outcomes for patients with acute appendicitis.
急诊手术与创伤（ESAT）团队是新加坡一项由专科医生主导的专门服务，旨在简化急诊外科工作量。由于急性阑尾炎是最常见的急性外科疾病之一，我们旨在比较ESAT模式下阑尾炎患者与传统随叫随到模式下患者的治疗结果。
回顾性分析新加坡 Khoo Teck Puat 医院在两个时间段收治的急性阑尾炎患者：2014 年 5 月至 10 月（ESAT 前 6 个月）与 2017 年 1 月至 6 月（ESAT 后）。评估患者人口统计学资料、手术细节、效率、临床结果及住院费用节省情况。
ESAT 前时期有 192 例患者，ESAT 后时期有 179 例患者。患者人口统计学资料和合并症具有可比性（>0.05）。ESAT 时期从急诊科转诊至外科会诊的时间显著缩短：分别为 77.8±46.9 分钟和 ESAT 前时期的 127±102 分钟（P = 0.002）。ESAT 时期从病例预约到手术室的时间显著更短：分别为 72.4±55.2分钟和 157.3±209.1 分钟（P<0.01）。ESAT 时期更多病例在白天进行，分别为 50.2%和 39.1%（P = 0.029）。ESAT 时期大多数患者接受腹腔镜阑尾切除术 156/179（87.2%），与 ESAT 前时期相比，开放性阑尾切除术较少 3/179（1.7%）（P = 0.062）。ESAT 时期术中专科医生监督率更高，分别为 38/166（22.9%）和 ESAT 前时期的 12/166（6.7%）（P = 0.001）。ESAT 时期并发症（Clavien-Dindo 二级及以上）较少，分别为 1 例（0.6%）和 ESAT 前时期的 6 例（3.4%）（P = 0.07）。
ESAT服务与急性阑尾炎患者更好的效率结果相关。
