Management of Acute Appendicitis by an Acute Care Surgery Service: Is Operative Intervention Timely?

Akpofure Peter Ekeh; Benjamin Monson; Curtis J. Wozniak; Matthew Armstrong; Mary C. McCarthy

doi:10.1016/j.jamcollsurg.2008.01.016

Management of Acute Appendicitis by an Acute Care Surgery Service: Is Operative Intervention Timely?

Akpofure Peter Ekeh, Benjamin Monson, Curtis J. Wozniak, Matthew Armstrong, Mary C. McCarthy

Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h4 id="x-x-x-absSec_1"> Background </h4> <p id="x-x-x-"> Trauma services are increasingly providing emergency surgery care by creating “acute care surgery” teams. We compared two periods at a Level I trauma center to determine if trauma service coverage would negatively impact timely management of acute appendicitis. <h4 id="x-x-x-absSec_2"> Study Design </h4> <p id="x-x-x-"> All patients admitted through the emergency department of a Level I trauma center who underwent appendectomies between March 2005 and May 2006 (Trauma period) were identified. During this period, the trauma service covered most surgical emergencies. Comparison was made with the earlier 15-month period (Pretrauma). Emergency department to operating room (OR) time, procedure length, and negative appendectomy rates were obtained. <h4 id="x-x-x-absSec_3"> Results </h4> <p id="x-x-x-"> In the Pretrauma period, 273 patients underwent appendectomy, compared with 279 in the Trauma period. Two-thirds (66%) of appendectomies in the Trauma period were performed by trauma surgeons. There was no difference in both periods with regard to mean emergency department to OR time (10.5 hours versus 9.9 hours; p = 0.4509), perforation rates (12% Pretrauma versus 7.5% Trauma; p = 0.1134), or negative appendectomy rates (17.9% Pretrauma versus 18.2% Trauma; p = 1.0). In the Trauma period, more appendectomies were completed laparoscopically (84.6% Trauma versus 66.6% Pretrauma; p < 0.0001), and mean OR time was shorter (57.4 minutes versus 67 minutes; p = 0.0006). <h4 id="x-x-x-absSec_4"> Conclusions </h4> <p id="x-x-x-"> In comparing two periods with and without the trauma service coverage of surgical emergencies, no difference was found in emergency department to OR time, perforation rates, or negative appendectomy rates in the management of acute appendicitis. There was a decrease in operative time and an increase in the proportion of laparoscopic appendectomies in the Trauma period. Trauma services can effectively incorporate emergency surgical coverage of procedures, such as appendectomies, without compromising timely intervention. </p> </p> </p> </p></p>

Original language	American English
Journal	Journal of the American College of Surgeons
Volume	207
DOIs	https://doi.org/10.1016/j.jamcollsurg.2008.01.016
State	Published - Jul 1 2008

Disciplines

Medical Specialties
Medicine and Health Sciences
Surgery

Access to Document

10.1016/j.jamcollsurg.2008.01.016License: CC BY

Cite this

@article{31ff70b2ed284031a8967eae16331ff3,

title = "Management of Acute Appendicitis by an Acute Care Surgery Service: Is Operative Intervention Timely?",

abstract = " Background Trauma services are increasingly providing emergency surgery care by creating “acute care surgery” teams. We compared two periods at a Level I trauma center to determine if trauma service coverage would negatively impact timely management of acute appendicitis. Study Design All patients admitted through the emergency department of a Level I trauma center who underwent appendectomies between March 2005 and May 2006 (Trauma period) were identified. During this period, the trauma service covered most surgical emergencies. Comparison was made with the earlier 15-month period (Pretrauma). Emergency department to operating room (OR) time, procedure length, and negative appendectomy rates were obtained. Results In the Pretrauma period, 273 patients underwent appendectomy, compared with 279 in the Trauma period. Two-thirds (66%) of appendectomies in the Trauma period were performed by trauma surgeons. There was no difference in both periods with regard to mean emergency department to OR time (10.5 hours versus 9.9 hours; p = 0.4509), perforation rates (12% Pretrauma versus 7.5% Trauma; p = 0.1134), or negative appendectomy rates (17.9% Pretrauma versus 18.2% Trauma; p = 1.0). In the Trauma period, more appendectomies were completed laparoscopically (84.6% Trauma versus 66.6% Pretrauma; p < 0.0001), and mean OR time was shorter (57.4 minutes versus 67 minutes; p = 0.0006). Conclusions In comparing two periods with and without the trauma service coverage of surgical emergencies, no difference was found in emergency department to OR time, perforation rates, or negative appendectomy rates in the management of acute appendicitis. There was a decrease in operative time and an increase in the proportion of laparoscopic appendectomies in the Trauma period. Trauma services can effectively incorporate emergency surgical coverage of procedures, such as appendectomies, without compromising timely intervention. ",

author = "Ekeh, {Akpofure Peter} and Benjamin Monson and Wozniak, {Curtis J.} and Matthew Armstrong and McCarthy, {Mary C.}",

year = "2008",

month = jul,

day = "1",

doi = "10.1016/j.jamcollsurg.2008.01.016",

language = "American English",