Clinical outcomes of the implementation of acute care surgery system in South Korea: a multi-centre, retrospective cohort study

BACKGROUND

In emergency general surgery (EGS), rapid judgement and prompt emergency surgery play a significant role in determining the patient's prognosis. This study aimed to evaluate whether implementing the acute care surgery (ACS) system in Korea has improved the clinical outcomes of patients.

METHODS

This retrospective cohort study was conducted at three tertiary hospitals in Korea. The study included patients aged 18-99 years who required EGS due to acute abdomen or abdominal trauma. A window period of 4 months was set after the implementation of the ACS system, and the clinical outcomes before and after the implementation were compared.

RESULTS

A total of 2146 patients were enrolled in the study, with 1008 in the pre-ACS group and 1138 in the post-ACS group. After propensity score matching, 901 patients were selected in the pre-ACS group and 906 patients were selected in the post-ACS group. The time from emergency room admission to operating room transfer was reduced in the post-ACS group, with a mean of 452.2 ± 347.0 min compared to 522.1 ± 416.5 min in the pre ACS group (P = 0.001). Moreover, the complication rates were reduced in the post-ACS group (38.3% vs. 31.3%, P = 0.006).

CONCLUSIONS

The implementation of the ACS system can lead to faster surgical decision-making and the prompt execution of emergency surgery for patients, thereby reducing postoperative complications.

Integrating acute care surgery in South Korea: enhancing trauma and non-trauma emergency care

BACKGROUND

Trauma surgery is a fundamental aspect of medicine. According to the 2023 mortality report from Statistics Korea, external factors such as intentional self-harm and transportation incidents are leading causes of death among individuals aged 10 to 30, accounting for 7.9% of overall mortality. Despite advances in the field, specialization has hindered comprehensive trauma care.

MAIN BODY

In South Korea, regional trauma centers have been established to meet critical trauma management needs; however, challenges remain, including a shortage of trauma surgeons and inefficient resource utilization. The reluctance of surgical residents to pursue trauma training exacerbates the scarcity of qualified specialists. Trauma surgeons often bear extensive responsibilities, which limits their ability to perform prompt interventions. Acute Care Surgery (ACS) offers a model to integrate trauma and non-trauma surgical care, enabling hospitals to implement effective protocols for urgent cases and improving patient outcomes. Research indicates that ACS enhances emergency surgical management, increases training opportunities for residents, and improves job satisfaction among participating surgeons.

CONCLUSION

Integrating ACS into South Korea's healthcare system is essential to optimize resource allocation and improve emergency care, ultimately leading to enhanced public health outcomes.

Outcomes in emergency surgery following the implementation of an acute care surgery model: a retrospective observational study

Purpose

Over the past 3 years, approximately 23,000 emergency surgeries were performed annually in South Korea, accounting for >1% of all surgeries nationwide. With the growing necessity for treating these emergency cases with dedication and proficiency, acute care surgery (ACS) teams were appointed at various hospitals. Regarding the implications of the ACS team, many studies showed promising results with a shorter time from the emergency department (ED) to the operating room (OR), shorter length of stay, and fewer complications. This study aimed to demonstrate the overall effect of ACS implementation at a single institution in South Korea.

Methods

This was a single-center, retrospective observational study. Patients aged >18 years who visited the emergency room and received emergency surgery between July 2014 and December 2016 (pre-ACS) and between July 2017 and December 2019 (post-ACS) were included.

Results

Among 958 patients, 497 were in the pre-ACS group and 461 in the post-ACS group. After propensity score matching by age, sex, underlying disease, and Emergency Surgery Acuity Score, 405 patients remained in each group. Our analysis showed a reduction in time from ED presentation to operation (547.8 ± 401.0 minutes vs. 476.6 ± 313.2 minutes, P = 0.005) and complication rates (24.7% vs. 16.8%, P < 0.001) in the post-ACS group. There were no significant differences in total operation duration, length of hospital stay, and mortality between the groups.

Conclusion

As expected, time from ED to OR and complication rates were significantly reduced in the post-ACS group. Implementing an ACS team dedicated to emergency surgery provides better clinical outcomes.

Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients

Purpose

Acute care surgery (ACS) has been practiced in several tertiary hospitals in South Korea since the late 2000s. The medical emergency team (MET) has improved the management of patients with clinical deterioration during hospitalization. This study aimed to identify the clinical effectiveness of collaboration between ACS and MET in hospitalized patients.

Methods

This was an observational before-and-after study. Emergency surgical cases of hospitalized patients were included in this study. Patients hospitalized in the Department of Emergency Medicine or Department of Surgery, directly comanaged by ACS were excluded. The primary outcome was in-hospital mortality rate. The secondary outcome was the alarm-to-operation interval, as recorded by a Modified Early Warning Score (MEWS) of >4.

Results

In total, 240 patients were included in the analysis (131 in the pre-ACS group and 109 in the post-ACS group). The in-hospital mortality rates in the pre- and post-ACS groups were 17.6% and 22.9%, respectively (P = 0.300). MEWS of >4 within 72 hours was recorded in 62 cases (31 in each group), and the median alarm-to-operation intervals of each group were 11 hours 16 minutes and 6 hours 41 minutes, respectively (P = 0.040).

Conclusion

Implementation of the ACS system resulted in faster surgical intervention in hospitalized patients, the need for which was detected early by the MET. The in-hospital mortality rates before and after ACS implementation were not significantly different.