急症护理手术模式：为高风险人群提供优质护理

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-11-17 DOI:10.1016/j.jss.2024.10.008

V. Christian Sanderfer MD, Erika Allen MD, Hannah Wang PhD, Bradley W. Thomas MD, Addison May MD, David Jacobs MD, Hailey Lewis BS, Julia Brake MS, Samuel W. Ross MD, Caroline E. Reinke MD, Cynthia Lauer MD

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引用次数: 0

摘要

导言急诊普通外科（EGS）是一种并发症多、死亡率高的疾病。种族、保险和社会经济地位与 EGS 患者的死亡率有关。急诊外科（ACS）模式曾改善了 EGS 患者的预后。我们假设，向 ACS 模式过渡将增加社区医院中服务不足和风险较高的 EGS 患者获得护理的机会，而死亡率不会发生变化。方法这项回顾性队列研究纳入了 2017 年至 2021 年的成人 EGS 患者，其当前程序术语（CPT）代码为结肠切除术、小肠切除术、消化性溃疡手术、阑尾切除术或胆囊切除术。2020 年 7 月，医院从传统模式过渡到 ACS 模式。对过渡前（ACS 前）42 个月和过渡后（ACS 后）18 个月的患者进行了分析。主要结果是死亡率；次要结果是术后 30 天急诊就诊率和再入院率。转型后，患者更可能是黑人、年龄更大、自费且埃利克豪斯综合指数（ECI）评分更高。转型后，胆囊切除术的比例上升，阑尾切除术的比例下降。调整年龄、种族和 ECI 后，30 天全因死亡率（0.9% 对 2.1%，P=0.63）、住院时间（2.7 天对 3 天，P=0.91）和术后急诊就诊率（7.5% 对 11.3%，P=0.16）均无变化。结论在实施 ACS 模式后，我们发现年龄较大、黑人、保险不足、ECI 较高的 EGS 患者有所增加，但死亡率没有变化。在社区医院实施 ACS 模式可增加服务不足和高风险患者群体获得优质护理的机会。

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Acute Care Surgery Model: High Quality Care for Higher Risk Populations

Introduction

Emergency General Surgery (EGS) represent a wide spectrum of diseases with high complication and mortality rates. Race, insurance, and socioeconomic status have been associated with mortality in EGS patients. Acute care surgery (ACS) models have previously shown improved outcomes for EGS patients. We hypothesized that transition to an ACS model would increase access to care for underserved and higher risk EGS patients in a community hospital, without a change in mortality.

Methods

This retrospective cohort study included adult EGS patients from 2017 to 2021 with current procedural terminology (CPT) codes of colectomy, small-bowel resection, peptic-ulcer surgery, appendectomy, or cholecystectomy. In July 2020, the hospital transitioned from a traditional model to an ACS model. Patients were analyzed for 42-month before (pre-ACS) and 18-month after (post-ACS) transition. Primary outcome was mortality; secondary outcomes were 30-day postoperative emergency department visits and readmission.

Results

We analyzed 467 pre-ACS and 238 post-ACS patients. After transition, patients were more likely to be Black, older, self-pay, and have higher Elixhauser Comorbidity Index (ECI) scores. Rates of cholecystectomies increased and appendectomies decreased after transition. Adjusting for age, race, and ECI, there were no changes in 30-day all-cause mortality (0.9% versus 2.1%, P = 0.63), length of stay (2.7-days versus 3-days, P = 0.91) and rate of postop emergency department visits (7.5% versus 11.3%, P = 0.16). There was a significant increase in hospital readmission after the ACS transition (5.1 versus 10.5%, P = 0.001, odds ratio 5.3).

Conclusions

After implementation of an ACS model, we found an increase in EGS patients who were older, Black, underinsured, with higher ECI without change in mortality. Implementation of ACS models at community hospitals may increase access to quality care for underserved and higher risk patient populations.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.