Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 8/2020

Open Access 01-08-2020 | Care | Scientific Review

Acute Care Surgery Models Worldwide: A Systematic Review

Authors: Mats J. L. van der Wee, Gwendolyn van der Wilden, Rigo Hoencamp

Published in: World Journal of Surgery | Issue 8/2020

Login to get access

Abstract

Background

The Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide.

Methods

A literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles.

Results

The search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care.

Conclusions

Large national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra- and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.
Appendix
Available only for authorised users
Literature
1.
Trzeciak S, Rivers EP (2003) Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 20:402–405PubMedPubMedCentral
2.
Horwitz LI, Green J, Bradley EH (2010) US emergency department performance on wait time and length of visit. Ann Emerg Med 55:133–141PubMed
3.
Committee to Develop the Reorganized Specialty of Trauma SCC, Emergency Surgery (2005) Acute care surgery: trauma, critical care, and emergency surgery. J Trauma 58:614–616
4.
Ball CG, Hameed SM, Brenneman FD (2010) Acute care surgery: a new strategy for the general surgery patients left behind. Can J Surg 53:84–85PubMedPubMedCentral
5.
Austin MT, Diaz JJ Jr, Feurer ID et al (2005) Creating an emergency general surgery service enhances the productivity of trauma surgeons, general surgeons and the hospital. J Trauma 58:906–910PubMed
6.
Britt RC, Weireter LJ, Britt LD (2009) Initial implementation of an acute care surgery model: implications for timeliness of care. J Am Coll Surg 209:421–424PubMed
7.
Ciesla DJ, Cha JY, Smith JS et al (2011) Implementation of an acute care surgery service at an academic trauma center. Am J Surg 202:779–785PubMed
8.
Matsushima K, Cook A, Tollack L et al (2011) An acute care surgery model provides safe and timely care for both trauma and emergency general surgery patients. J Surg Res 166:143–147
9.
10.
Barnes SL, Cooper CJ, Coughenour JP et al (2011) Impact of acute care surgery to departmental productivity. J Trauma 71:1027–1032PubMed
11.
Sweeting RS, Carter JE, Meyer AA et al (2013) The price of acute care surgery. J Trauma Acute Care Surg 74:1239–1242PubMed
12.
Cherry-Bukowiec JR, Miller BS, Doherty GM et al (2011) Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training. J Trauma 71:1422–1426PubMed
13.
Bruns BR, Tesoriero RB, Narayan M et al (2016) Acute care surgery and emergency general surgery: addition by subtraction. J Trauma Acute Care Surg 81:131–136PubMed
14.
Cubas RF, Gomez NR, Rodriguez S et al (2012) Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost. J Am Coll Surg 215:715–721PubMed
15.
Qureshi A, Smith A, Wright F et al (2011) The impact of an acute care emergency surgical service on timely surgical decision-making and emergency department overcrowding. J Am Coll Surg 213:284–293PubMed
16.
Diaz JJ Jr, Norris PR, Gunter OL et al (2011) Does regionalization of acute care surgery decrease mortality? J Trauma 71:442–446PubMed
17.
Ekeh AP, Monson B, Wozniak CJ et al (2008) Management of acute appendicitis by an acute care surgery service: is operative intervention timely? J Am Coll Surg 207:43–48PubMed
18.
Miller PR, Wildman EA, Chang MC et al (2012) Acute care surgery: impact on practice and economics of elective surgeons. J Am Coll Surg 214:531–535PubMed
19.
Procter L, Bernard AC, Korosec RL et al (2013) An acute care surgery service generates a positive contribution margin in an appropriately staffed hospital. J Am Coll Surg 216:298–301PubMed
20.
Pryor JP, Reilly PM, Schwab CW et al (2004) Integrating emergency general surgery with a trauma service: impact on the care of injured patients. J Trauma 57:467–471PubMed
21.
Chana P, Burns EM, Arora S et al (2016) A systematic review of the impact of dedicated emergency surgical services on patient outcomes. Ann Surg 263:20–27PubMed
22.
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine 6:e1000097PubMedPubMedCentral
23.
24.
Kim TJ, von dem Knesebeck O (2018) Income and obesity: what is the direction of the relationship? A systematic review and meta-analysis. BMJ Open 8:e019862PubMedPubMedCentral
25.
Santry HP, Pringle PL, Collins CE et al (2014) A qualitative analysis of acute care surgery in the United States: it’s more than just “a competent surgeon with a sharp knife and a willing attitude”. Surgery 155:809–825PubMed
26.
Santry HP, Madore JC, Collins CE et al (2015) Variations in the implementation of acute care surgery: results from a national survey of university-affiliated hospitals. J Trauma Acute Care Surg 78:60–67PubMedPubMedCentral
27.
Garland AM, Riskin DJ, Brundage SI et al (2007) A county hospital surgical practice: a model for acute care surgery. Am J Surg 194:758–763PubMed
28.
Ladhani HA, Posillico SE, Zosa BM et al (2018) Efficiency of care and cost for common emergency general surgery conditions: comparison by surgeon training and practice. Surgery 164:651–656PubMed
29.
Anantha RV, Parry N, Vogt K et al (2014) Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective. Can J Surg 57:9–14
30.
DeGirolamo K, D’Souza K, Apte S et al (2018) A day in the life of emergency general surgery in Canada: a multicentre observational study. Can J Surg 61:13517PubMed
31.
Faryniuk AM, Hochman DJ (2013) Effect of an acute care surgical service on the timeliness of care. Can J Surg 56:187–191PubMedPubMedCentral
32.
Kreindler SA, Zhang L, Metge CJ et al (2013) Impact of a regional acute care surgery model on patient access and outcomes. Can J Surg 56:318–324PubMedPubMedCentral
33.
van Zyl TJ, Murphy PB, Allen L et al (2018) Beyond just the operating room: characterizing the complete caseload of a tertiary acute care surgery service. Can J Surg 61:7417PubMed
34.
Wanis KN, Hunter AM, Harington MB et al (2014) Impact of an acute care surgery service on timeliness of care and surgeon satisfaction at a Canadian academic hospital: a retrospective study. World J Emerg Surg 9:4PubMedPubMedCentral
35.
Poggetti R, Leppanemi A, Ferrada P et al (2009) WSES SM (World Society of Emergency Surgery Summer Meeting) highlights: emergency surgery around the world (Brazil, Finland, USA). World J Emerg Surg 4:11PubMedPubMedCentral
36.
Allaway MGR, Eslick GD, Kwok GTY et al (2017) The Established Acute Surgical Unit: a reduction in nighttime appendicectomy without increased morbidity. Int J Surg 43:81–85PubMed
37.
Beardsley CJ, Sandhu T, Gubicak S et al (2014) Model-based evaluation of the Canberra Hospital Acute Care Surgical Unit: acute care surgery: a case of one size fits all? Surg Today 44:884–887PubMed
38.
Cox MR, Cook L, Dobson J et al (2010) Acute Surgical Unit: a new model of care. ANZ J Surg 80:419–424PubMed
39.
Dickfos M, Ibrahim H, Evans A et al (2018) Cohort study on emergency general surgery patients and an observation unit. ANZ J Surg 88:713–717PubMed
40.
Gandy RC, Truskett PG, Wong SW et al (2010) Outcomes of appendicectomy in an acute care surgery model. Med J Aust 193:281–284PubMed
41.
Guy S, Lisec C (2018) Emergency laparotomy outcomes before and after the introduction of an acute surgical unit. International Journal of Surgery Open 10:61–65
42.
Kinnear N, Britten-Jones P, Hennessey D et al (2017) Impact of an acute surgical unit on patient outcomes in South Australia. ANZ J Surg 87:825–829PubMed
43.
44.
Lehane CW, Jootun RN, Bennett M et al (2010) Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J Surg 80:438–442PubMed
45.
Musiienko AM, Shakerian R, Gorelik A et al (2016) Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction. ANZ J Surg 86:831–835PubMed
46.
Parasyn AD, Truskett PG, Bennett M et al (2009) Acute-care surgical service: a change in culture. ANZ J Surg 79:12–18PubMed
47.
Pepingco L, Eslick GD, Cox MR (2012) The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis. Med J Aust 196:509–510PubMed
48.
49.
Shakerian R, Thomson BN, Gorelik A et al (2015) Outcomes in emergency general surgery following the introduction of a consultant-led unit. Br J Surg 102:1726–1732PubMed
50.
Suhardja TS, Bae L, Seah EZ et al (2015) Acute surgical unit safely reduces unnecessary after-hours cholecystectomy. Ann R Coll Surg Engl 97:568–573PubMedPubMedCentral
51.
Von Conrady D, Hamza S, Weber D et al (2010) The acute surgical unit: improving emergency care. ANZ J Surg 80:933–936
52.
Wang E, Jootun R, Foster A (2018) Management of acute appendicitis in an acute surgical unit: a cost analysis. ANZ J Surg 88:1284–1288PubMed
53.
Suen K, Hayes IP, Thomson BN et al (2014) Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy. Br J Surg 101:141–146
54.
55.
Hsee L, Devaud M, Middelberg L et al (2012) Acute Surgical Unit at Auckland City Hospital: a descriptive analysis. ANZ J Surg 82:588–591PubMed
56.
Pillai S, Hsee L, Pun A et al (2013) Comparison of appendicectomy outcomes: acute surgical versus traditional pathway. ANZ J Surg 83:739–743PubMed
57.
Poh BR, Cashin P, Dubrava Z et al (2013) Impact of an acute care surgery model on appendicectomy outcomes. ANZ J Surg 83:735–738PubMed
58.
Poole GH, Glyn T, Srinivasa S et al (2012) Modular acute system for general surgery: hand over the operation, not the patient. ANZ J Surg 82:156–160PubMed
59.
Bokhari S, Kulendran M, Liasis L et al (2015) Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis. Ann R Coll Surg Engl 97:308–314PubMedPubMedCentral
60.
Bokhari S, Walsh U, Qurashi K et al (2016) Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis. Ann R Coll Surg Engl 98:107–115PubMedPubMedCentral
61.
Navarro AP, Hardy E, Oakley B et al (2017) The front-line general surgery consultant as a new model of emergency care. Ann R Coll Surg Engl 99:550–554PubMedPubMedCentral
62.
Sorelli PG, El-Masry NS, Dawson PM et al (2008) The dedicated emergency surgeon: towards consultant-based acute surgical admissions. Ann R Coll Surg Engl 90:104–108PubMedPubMedCentral
63.
Tincknell L, Burton S, Cooke C et al (2009) The emergency surgical team - the way forward in emergency care? Ann R Coll Surg Engl 91:18–22PubMedPubMedCentral
64.
al-Ayoubi F, Eriksson H, Myrelid P et al (2012) Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care? Scand J Trauma Resusc Emerg Med 20:66PubMedPubMedCentral
65.
Mathur S, Lim WW, Goo TT (2018) Emergency general surgery and trauma: outcomes from the first consultant-led service in Singapore. Injury 49:130–134PubMed
66.
Fu CY, Huang HC, Chen RJ (2014) Implementation of the acute care surgery model provides benefits in the surgical treatment of the acute appendicitis. Am J Surg 208:794–799PubMed
67.
Klopper JH, Rayamajhi S, Venter JJ (2017) Provision of acute and elective general surgical care at a tertiary facility in the era of subspecialisation. S Afr Med J 107(948):951
68.
Moodie Q (2015) An audit of the workload of an Acute Care Surgery Unit in a tertiary academic hospital before and after the closure of a Referring Community Hospital. University of Cape Town
69.
Mpirimbanyi C, Nyirimodoka A, Lin Y et al (2017) Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes. BMC Surg 17:121PubMedPubMedCentral
70.
71.
Ang ZH, Wong S, Truskett P (2019) General surgeons Australia’s 12-point plan for emergency general surgery. ANZ J Surg 89:809–814PubMed
72.
Koea JB, Srinivasa S, Hundal H (2014) Provision of acute general surgery: a systematic review of models of care. J Trauma Acute Care Surg 76:219–225PubMed
73.
74.
Aranda-Narvaez JM, Tallon-Aguilar L, Lopez-Ruiz JA et al (2019) The Acute Care Surgery model in the world, and the need for and implementation of trauma and emergency surgery units in Spain. Cir Esp 97:3–10PubMed
Metadata
Title
Acute Care Surgery Models Worldwide: A Systematic Review
Authors
Mats J. L. van der Wee
Gwendolyn van der Wilden
Rigo Hoencamp
Publication date
01-08-2020
Publisher
Springer International Publishing
Keyword
Care
Published in
World Journal of Surgery / Issue 8/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05536-9

Other articles of this Issue 8/2020

World Journal of Surgery 8/2020 Go to the issue

Original Scientific Report

Increased Survival Benefit of Adjuvant Intra-arterial Infusion Chemotherapy in HCC Patients with Portal Vein Infiltration after Hepatectomy

Letter to the Editor

Letter to the Editor: O2 No Longer the Go2: A Systematic Review and Meta-analysis Comparing the Effects of Giving Perioperative Oxygen Therapy of 30% FiO2 to 80% FiO2 on Surgical Site Infection and Mortality

Original Scientific Report

Safety of Major Abdominal Operations in the Elderly: A Study of Geriatric-Specific Determinants of Health

Scientific Review

Hazardous Postoperative Outcomes of Unexpected COVID-19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment

Original Scientific Report

Diagnostic Performance of Neck Ultrasonography in the Preoperative Evaluation for Extrathyroidal Extension of Suspicious Thyroid Nodules

Original Scientific Report

Feasibility of an Enhanced Recovery Protocol for Elective Pancreatoduodenectomy: A Multicenter International Cohort Study