응급수술팀 모델 도입이 응급수술 결과에 미치는 영향

Abstract

Background Over the past three 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 ER 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. Although our analysis showed no significant differences in mortality between the pre-ACS and the post-ACS group (2.4% vs 3.4%, P = 0.408, respectively), it showed a reduction in time from ED presentation to operation (547.8 ± 401.0 vs. 476.6 ± 313.2 minutes, P = 0.005) and complication rates (24.7% vs. 16.8%, P < 0.001). There were no significant differences in total operation duration and length of hospital stay. Conclusions Although mortality was not reduced in the post-ACS group as expected, time from ED to OR and complication rates were significantly reduced in the post-ACS group. We can state that implementing an ACS team dedicated to emergency surgery provides safe and better clinical outcomes.