Gounder Jaya, Dissanayake Bhanuka, Burstow Matthew J, Yuide Peter J, Naidu Sanjeev, Lancashire Raymond P, Chua Terence C
Department of Surgery, QEII Jubilee Hospital, Brisbane, Queensland, Australia.
School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
ANZ J Surg. 2021 Apr;91(4):616-621. doi: 10.1111/ans.16558. Epub 2021 Jan 18.
In Australia, there has been a shift from the traditional 'on-call' surgical model to the 'acute surgical unit' (ASU) model to improve outcomes in acute general surgery. Using emergency appendicectomy as a standardized procedure, we aimed to identify the different patterns of care between these on-call structures by comparing two metropolitan district hospitals; one that employs a traditional on-call model and the other, which employ the ASU model.
Data on consecutive patients undergoing emergency appendectomies at the two hospitals (traditional and ASU model) between July 2018 and December 2018 were retrieved for retrospective review. Patient factors, preoperative factors, operative factors and post-operative outcomes were collected and tabulated for comparative analysis between the traditional versus ASU model of care.
Univariate analysis demonstrated that there were a greater proportion of consultant-led cases (P < 0.001), a shorter time to theatre (P = 0.047) and a greater number of out-of-hours operations (P < 0.001) in the ASU model compared to the traditional model. A larger proportion of patients from the traditional model underwent a computed tomography scan as part of their diagnostic workup compared to the ASU model (P < 0.001). There was no difference in negative appendicectomy rates, intraoperative conversion rates, post-operative complication rates or mean lengths of hospital stay between the two on-call models.
The ASU and traditional on-call model appears to achieve equivalent care outcomes for patients with acute appendicitis.
在澳大利亚，为改善急性普通外科手术的治疗效果，已从传统的“随叫随到”手术模式转变为“急性外科单元”（ASU）模式。我们以急诊阑尾切除术作为标准化手术，旨在通过比较两家大都市地区医院来确定这些随叫随到结构之间不同的护理模式；一家采用传统随叫随到模式，另一家采用ASU模式。
检索2018年7月至2018年12月期间在两家医院（传统模式和ASU模式）接受急诊阑尾切除术的连续患者的数据进行回顾性分析。收集患者因素、术前因素、手术因素和术后结果，并列表进行传统护理模式与ASU护理模式之间的比较分析。
单因素分析表明，与传统模式相比，ASU模式中由顾问主导的病例比例更高（P < 0.001），到手术室的时间更短（P = 0.047），非工作时间手术的数量更多（P < 0.001）。与ASU模式相比，传统模式中有更大比例的患者在诊断检查中接受了计算机断层扫描（P < 0.001）。两种随叫随到模式在阴性阑尾切除率、术中中转率、术后并发症发生率或平均住院时间方面没有差异。
ASU模式和传统随叫随到模式对急性阑尾炎患者似乎能实现同等的护理效果。
