Al Babtain Ibrahim, Alraee Sondus A, Shalhoub Mishary M, Hijazi Leen O, Albalawi Arwa A, Alamer Modhi
Department of General Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU.
Medicine and Surgery, King Saud bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU.
Cureus. 2022 Jul 10;14(7):e26724. doi: 10.7759/cureus.26724. eCollection 2022 Jul.
Background Acute care surgery (ACS) is a novel model for the provision of emergency general surgery (GS) care. Investigating the impact of the ACS team on the management of acute emergencies can help in establishing proper management measures and improving patient care in an emergency setting. The study aims to compare the performance indicators and patient outcomes such as hospital length of stay (LOS), time to diagnosis, and operation before and after the implementation of the acute care system. Methods The study reviewed two retrospective cohorts: the pre-ACS system (n = 202) from January 2012 to December 2013 and the post-ACS system (n = 188) from January 2014 to December 2015, which were done in a tertiary care center. All adult patients diagnosed with acute appendicitis and cholecystitis requiring emergency surgery were included. Results There was an improvement in the time interval between GS referral to the diagnosis of acute appendicitis and cholecystitis (p = 0.07) and from diagnosis to the start of the operation (p = 0.38). Patients in the post-ACS model had a shorter hospital stay than the pre-ACS model patients with [M = 3.69 SD(3.18) days versus M = 3.57 SD (3.60) days, p = 0.25]. Time from the emergency department arrival to GS referral did not show an improvement [M = 4.36 SD(3.34)] hours in the pre-ACS model versus [M = 4.53 SD(3.98)] hours in the ACS model, p = 0.86). Conclusion The ACS model led to earlier diagnosis of acute appendectomy and cholecystectomy cases and reduced the LOS. The introduction of the ACS model in Saudi Arabia showed improvement in patient care during acute emergencies. Further studies including multiple centers with larger sample sizes and longer review periods are needed to evaluate the efficiency and cost-effectiveness of the ACS model.
急性护理手术（ACS）是一种提供急诊普通外科（GS）护理的新模式。研究ACS团队对急性紧急情况管理的影响有助于制定适当的管理措施，并改善急诊环境中的患者护理。本研究旨在比较急性护理系统实施前后的绩效指标和患者结局，如住院时间（LOS）、诊断时间和手术时间。方法：本研究回顾了两个回顾性队列：2012年1月至2013年12月的ACS系统前队列（n = 202）和2014年1月至2015年12月的ACS系统后队列（n = 188），研究在一家三级护理中心进行。纳入所有诊断为急性阑尾炎和胆囊炎且需要急诊手术的成年患者。结果：从GS转诊到急性阑尾炎和胆囊炎诊断的时间间隔（p = 0.07）以及从诊断到手术开始的时间间隔（p = 0.38）有所改善。ACS模式后的患者住院时间比ACS模式前的患者短[M = 3.69，标准差（3.18）天对M = 3.57，标准差（3.60）天，p = 0.25]。从急诊科到达至GS转诊的时间在ACS系统前队列中未显示改善[M = 4.36，标准差（3.34）小时]，而在ACS系统队列中为[M = 4.53，标准差（3.98）小时]，p = 0.86）。结论：ACS模式导致急性阑尾炎和胆囊炎病例的诊断更早，并缩短了住院时间。在沙特阿拉伯引入ACS模式显示在急性紧急情况下患者护理有所改善。需要进一步开展包括多个中心、更大样本量和更长回顾期的研究，以评估ACS模式的效率和成本效益。
