Key result
Acute surgical units show no benefit over traditional models for managing or communicating incidental findings.
Why the study?
Important incidental pathology requiring further action is commonly found during appendicectomy, but whether an acute surgical unit model improved management and disclosure remained unknown.
Does an acute surgical unit (ASU) model improve the management and communication of incidental pathology in patients undergoing emergency appendicectomy?
Cohort (n=1,214)
No
Does an acute surgical unit (ASU) model improve the management and communication of incidental pathology in patients undergoing emergency appendicectomy?
p-value: p=0.21, 0.44, 0.27
The introduction of an acute surgical unit model did not improve the rates of appropriate management or communication of important incidental pathology found during emergency appendicectomy.
Acute surgical unit model shows no benefit for incidental pathology; hypothesis-generating and should not change practice.
BACKGROUND: Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. We aimed to determine whether the acute surgical unit (ASU) model improved the management and disclosure of these findings. METHODS: An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings, and communication of the findings to the patient and to their general practitioner (GP). RESULTS: 1,214 patients underwent emergency appendicectomy; 465 in the Traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the Traditional and ASU group with regards to communication of the findings to the patient (p = 0.44) and their GP (p = 0.27), and there was no difference in the rates of appropriate management (p = 0.21). CONCLUSION: The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during appendectomy.
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Kinnear et al. (2019) conducted a cohort in Appendicectomy with incidental pathology (n=1,214). Acute surgical unit (ASU) model vs. Traditional model was evaluated on Rates of appropriate management of incidental findings, and communication to the patient and GP (p=0.21, 0.44, 0.27). The acute surgical unit model did not improve appropriate management (p=0.21) or communication of incidental pathology to patients (p=0.44) and GPs (p=0.27) compared to the traditional model.