Shift-based models for acute surgical care (ACS), where surgical emergencies are treated
by a dedicated team of surgeons working shifts, without a concurrent elective practice,
are becoming more common nationwide. We compared the outcomes for appendectomy, one
of the most common emergency surgical procedures, between the traditional (TRAD) call
and ACS model at the same institution during the same time frame.
A retrospective review of patients who underwent laparoscopic appendectomy for acute
appendicitis during 2017-2018. ACS and TRAD-patient demographics, clinical presentation,
operative details, and outcomes were compared using independent sample t-tests, Wilcoxon rank-sum tests and Fisher's exact or χ2 tests. Multiple exploratory regression models were constructed to examine the effects
of confounding variables.
Demographics, clinical presentation, and complication rates were similar between groups
except for a longer duration of symptoms prior to arrival in the TRAD group (Δ = 0.5 d,
P = 0.006). Time from admission to operating room (Δ = −1.85 h, P = 0.003), length of hospital stay (Δ = −2.0 d, P < 0.001), and total cost (Δ = $ −2477.02, P < 0.001) were significantly lower in the ACS group compared to the TRAD group. Furthermore,
perforation rates were lower in ACS (8.3% versus 28.6%, P = 0.003). Differences for the outcomes remained significant even after controlling
for duration of symptoms prior to arrival (P < 0.05).
Acute appendicitis managed using the ACS shift-based model seems to be associated
with reduced time to operation, hospital stay, and overall cost, with equivalent success
rates, compared to TRAD.