Impact of the Acute Care Surgery Model on Disease- and Patient-Specific Outcomes in Appendicitis and Biliary Disease: A Meta-Analysis

Background: The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured emergency general surgery patient population, however, there are variations in the design of ACS service models. This meta-analysis analyzes the impact of implementation of different ACS models on the outcomes for appendicitis and biliary disease.

Study design: A systematic, English-language search of major databases was conducted. From 1,827 papers, 2 independent reviewers identified 25 studies that reported on outcomes for patients with appendicitis (n = 13), biliary disease (n = 7), or both (n = 5), before and after implementation of an ACS service. The Newcastle-Ottawa Scale was used to score quality. Outcomes were analyzed using random effect methodology and sensitivity analyses were performed.

Results: Significant heterogeneity existed between studies and ACS designs. The overall study quality rating was fair to poor with a moderate risk of bias. After implementation of an ACS service, there was an overall reduction in length of stay by 0.51 days (95% CI -0.81 to -0.20 days) and 0.73 days (95% CI 0.09 to 1.36 days) for appendicitis and biliary disease, respectively. Complication rates were lower after implementing ACS (odds ratio 0.65; 95% CI 0.49 to 0.86 and odds ratio 0.46; 95% CI 0.34 to 0.61). There was no difference in after-hours operating for either appendicitis or biliary disease, except when considering ACS models with dedicated theater time, which favors an ACS model (odds ratio 0.49; 95% CI 0.33 to 0.73) in appendicitis.

Conclusions: The ACS model has been shown to benefit acute care surgery patients with improved access to care, fewer complications, and decreased length of stay for 2 common disease processes. The design and implementation of an ACS service can impact the magnitude of effect.