V. C. Sanderfer3, E. Allen3, B. W. Thomas3, D. G. Jacobs3, A. K. May3, H. Wang2, K. Thompson2, J. Brake3, H. Lewis3, C. E. Reinke3, S. Ross3, C. Lauer3 2Atrium Health, Carolinas Center For Surgical Outcomes Science, Charlotte, NC, USA 3Atrium Health, Carolinas Medical Center, Department Of Surgery, Charlotte, NC, USA
Introduction: Emergency General Surgery (EGS) disorders represent a wide spectrum of diseases with high complication and mortality rates. Race, insurance, and socioeconomic status have been associated with mortality in the EGS population. Acute care surgery (ACS) models, with surgeons focusing on unscheduled surgery, have been associated with improved outcomes for EGS patients. We hypothesized that transition to an ACS model would improve access to care for underserved and higher risk EGS patients in a busy community hospital, without a change in mortality.
Methods: This retrospective cohort study included adult EGS patients from 2017-2021 with CPT codes of colectomy, small bowel resection, peptic ulcer surgery, appendectomy, or cholecystectomy. In July 2020, a regional hospital transitioned from a general surgeon on call model to an ACS coverage model. Patients were analyzed for 42 months before (Pre-ACS) and 18 months after (Post-ACS) the transition. Primary outcome was mortality; secondary outcomes were LOS and postop ED visits.
Results: A total of 765 patients were analyzed; 511 Pre-ACS and 254 Post-ACS patients. After transition to an ACS model, patients were more likely to be Black, older, self-pay, and have higher Elixhauser-Comorbidity Index (ECI) scores. The rate of cholecystectomies increased and appendectomies decreased after the transition. After adjusting for age, race, insurance, and ECI, there were no differences in 30-day all-cause mortality (0.6% vs 1.6%, p= 0.71, OR 1.4 [0.3-7.6]), length of stay (2.7 days vs 3 days, p=0.49, IRR 1 [0.9-1.2]), and rate of postop ED visits (11% vs 7.2%, p= 0.19, OR 1.4 [0.8-2.4]).
Conclusion: The implementation of an ACS model of care resulted in an increase in age, patients of Black race, and self-paying EGS patients with a higher ECI, with no change in mortality. Implementation of the ACS model at community hospitals may improve access to quality care for underserved and higher risk patient populations.
