Ten years of acute care surgery in Singapore: evolution, outcomes and future challenges

BACKGROUND: Acute Care Surgery (ACS) has emerged as a structured solution to challenges in emergency general surgery (EGS), including subspecialisation, fragmented coverage, and delays in operative care. METHODS: This narrative review outlines the global ACS evolution and examines Singapore's experience over the past decade, focusing on implementation models, outcomes, and ongoing challenges. RESULTS: Since 2014, Singapore's public hospitals have adopted variations of the ACS framework, ranging from consultant of the week rosters to dedicated full time ACS teams. These models have improved timeliness of care, efficiency, and surgical training. Innovations such as Emergency Laparotomy Pathways and abscess protocols reduced delays and improved perioperative coordination. Local outcomes demonstrate reduced time to intervention by 30-40%, shorter hospital stays by 1-2d and sustained improvements in morbidity and mortality. However, challenges persist in trauma workforce sustainability, registrar training variability, theatre access, and the absence of national credentialing. CONCLUSION: ACS has improved the delivery of emergency and trauma surgery in Singapore. To sustain these gains, national credentialing, workforce planning, and structured training frameworks are required to secure ACS as a core part of the surgical system.