Rosenzveig Alicia, Jarrar Amer, Stuleanu Tommy, Mamazza Joseph, Neville Amy, Walsh Caolan, Murphy Patrick B, Kolozsvari Nicole
From the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alta. (Rosenzveig); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Jarrar, Stuleanu, Mamazza, Neville, Walsh, Kolozsvari); the Ottawa Hospital, Ottawa, Ont. (Stuleanu, Mamazza, Neville, Walsh, Kolozsvari); the Division of Trauma/Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis. (Murphy).
From the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alta. (Rosenzveig); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Jarrar, Stuleanu, Mamazza, Neville, Walsh, Kolozsvari); the Ottawa Hospital, Ottawa, Ont. (Stuleanu, Mamazza, Neville, Walsh, Kolozsvari); the Division of Trauma/Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis. (Murphy)
Can J Surg. 2024 Aug 1;67(4):E307-E312. doi: 10.1503/cjs.000724. Print 2024 Jul-Aug.
Patients who require emergency general surgery (EGS) are at a substantially higher risk for perioperative morbidity and mortality than patients undergoing elective general surgery. The acute care surgery (ACS) model has been shown to improve EGS patient outcomes and cost-effectiveness. A recent systematic review has shown extensive heterogeneity in the structure of ACS models worldwide. The objective of this study was to describe the current landscape of ACS models in academic centres across Canada.
We sent an online questionnaire to the 18 academic centres in Canada. The lead ACS physicians from each institution completed the questionnaire, describing the structure of their ACS models.
In total, 16 institutions responded, all of which reported having ACS models, with a total of 29 ACS services described. All services had resident coverage. Of the 29, 18 (62%) had dedicated allied health care staff. The staff surgeon was free from elective duties while covering ACS in 17/29 (59%) services. More than half (15/29; 52%) of the services described protected ACS operating room time, but only 7/15 (47%) had a dedicated ACS room all 5 weekdays. Four of 29 services (14%) had no protected ACS operating room time. Only 1/16 (6%) institutions reported a mandate to conduct ACS research, while 12/16 (75%) found ACS research difficult, owing to lack of resources.
We saw large variations in the structure of ACS models in academic centres in Canada. The components of ACS models that are most important to patient outcomes remain poorly defined. Future research will focus on defining the necessary cornerstones of ACS models.
与接受择期普通外科手术的患者相比，需要急诊普通外科手术（EGS）的患者围手术期发病率和死亡率显著更高。急性护理手术（ACS）模式已被证明可改善EGS患者的治疗效果和成本效益。最近的一项系统评价显示，全球范围内ACS模式的结构存在广泛的异质性。本研究的目的是描述加拿大各学术中心当前的ACS模式情况。
我们向加拿大的18个学术中心发送了一份在线问卷。每个机构的首席ACS医生完成了问卷，描述了他们的ACS模式结构。
共有16个机构做出回应，所有机构均报告有ACS模式，共描述了29项ACS服务。所有服务都有住院医师值班。在这29项服务中，18项（62%）有专门的联合医疗保健人员。在17/29（59%）的服务中， staff surgeon在负责ACS期间无需承担择期工作。超过一半（15/29；52%）的服务描述了有保护的ACS手术室时间，但只有7/15（47%）在所有工作日都有专门的ACS手术室。29项服务中有4项（14%）没有受保护的ACS手术室时间。只有1/16（6%）的机构报告有开展ACS研究的任务，而12/16（75%）的机构因缺乏资源而认为ACS研究困难。
我们发现加拿大各学术中心的ACS模式结构存在很大差异。对患者治疗效果最重要的ACS模式组成部分仍未明确界定。未来的研究将集中于确定ACS模式的必要基石。
