1
|
|
2
|
Wright GP, Ecker AM, Hobbs DJ, Wilkes AW, Hagelberg RS, Rodriguez CH, Scholten DJ. Old dogs and new tricks: length of stay for appendicitis improves with an acute care surgery program and transition from private surgical practice to multispecialty group practice. Am Surg 2014; 80:1250-1255. [PMID: 25513925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute care surgery (ACS) programs have emerged mainly at academic medical centers to provide timely care for emergency general surgery and trauma patients. We hypothesized that the development of an ACS program in a multispecialty group practice would improve outcomes for patients with acute appendicitis. A retrospective analysis of patients with acute appendicitis was performed in two time periods: 18 months of private practice and the following 12 months with ACS coverage. Length of stay was the primary outcome measure. A total of 871 patients were studied (526 private practice, 345 ACS). The ACS group had a greater proportion of laparoscopic appendectomies (P < 0.001) and more transitions in care between surgeons (P < 0.001). Length of stay was shorter in the ACS group (1.6 ± 1.5 [mean ± standard deviation] vs 1.9 ± 2.4 days, P = 0.01) and a greater proportion of surgeries were performed during the daytime (44.9 vs 36.6%, P = 0.02). Multivariate analysis demonstrated length of stay was related to appendicitis grade (P < 0.001), American Society of Anesthesiologists class (P < 0.001), symptom duration (P = 0.001), and laparoscopic approach (P < 0.001). The initial transition from private practice to ACS resulted in decreased length of stay with no increase in morbidity related to transitions of surgical care in patients with appendicitis.
Collapse
Affiliation(s)
- G Paul Wright
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan, USA
| | | | | | | | | | | | | |
Collapse
|
3
|
Wright GP, Ecker AM, Hobbs DJ, Wilkes AW, Hagelberg RS, Rodriguez CH, Scholten DJ. Old Dogs and New Tricks: Length of Stay for Appendicitis Improves with an Acute Care Surgery Program and Transition from Private Surgical Practice to Multispecialty Group Practice. Am Surg 2014. [DOI: 10.1177/000313481408001228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute care surgery (ACS) programs have emerged mainly at academic medical centers to provide timely care for emergency general surgery and trauma patients. We hypothesized that the development of an ACS program in a multispecialty group practice would improve outcomes for patients with acute appendicitis. A retrospective analysis of patients with acute appendicitis was performed in two time periods: 18 months of private practice and the following 12 months with ACS coverage. Length of stay was the primary outcome measure. A total of 871 patients were studied (526 private practice, 345 ACS). The ACS group had a greater proportion of laparoscopic appendectomies ( P < 0.001) and more transitions in care between surgeons ( P < 0.001). Length of stay was shorter in the ACS group (1.6 ± 1.5 [mean ± standard deviation] vs 1.9 ± 2.4 days, P = 0.01) and a greater proportion of surgeries were performed during the daytime (44.9 vs 36.6%, P = 0.02). Multivariate analysis demonstrated length of stay was related to appendicitis grade ( P < 0.001), American Society of Anesthesiologists class ( P < 0.001), symptom duration ( P = 0.001), and laparoscopic approach ( P < 0.001). The initial transition from private practice to ACS resulted in decreased length of stay with no increase in morbidity related to transitions of surgical care in patients with appendicitis.
Collapse
Affiliation(s)
- G. Paul Wright
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
| | - Amie M. Ecker
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
| | - David J. Hobbs
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
| | - Alexander W. Wilkes
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
| | - Richard S. Hagelberg
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
- Spectrum Health Medical Group, Division of Surgical Specialists, Grand Rapids, Michigan
| | - Carlos H. Rodriguez
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
- Spectrum Health Medical Group, Division of Surgical Specialists, Grand Rapids, Michigan
| | - Donald J. Scholten
- GRMEP/Michigan State University General Surgery Residency, Grand Rapids, Michigan; the
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; and
- Spectrum Health Medical Group, Division of Surgical Specialists, Grand Rapids, Michigan
| |
Collapse
|