Key result
The acute surgical unit model for appendectomy significantly reduced complication rates (OR 0.76; 95% CI 0.59-0.99; P=0.04) and shortened time to theatre compared to traditional models.
Why the study?
Does an acute surgical unit (ASU) model improve outcomes in patients undergoing emergency appendectomy compared to a traditional model?
Meta-Analysis (n=7,980)
Does an acute surgical unit (ASU) model improve outcomes in patients undergoing emergency appendectomy compared to a traditional model?
Odds Ratio: 0.76 (95% CI 0.59–0.99)
p-value: p=0.04
An acute surgical unit model improves time to theatre, length of stay, and complication rates for emergency appendectomy patients compared to traditional models.
BACKGROUND: The provision of emergency general surgical services is undergoing a paradigm shift towards a consultant led, patient centered model in order to improve patient outcomes. The aim of this current study is to use meta-analytical techniques to assess the efficacy of acute surgical unit (ASU) in appendectomy. METHODS: A meta-analysis was conducted according to the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus for published studies comparing ASU and traditional (TRAD) model on appendectomy outcomes was performed. Random-effects methods were used to analyze key outcomes with data presented as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Fourteen comparative studies describing outcomes in 7980 patients were identified, 4258 patients were included in the ASU model (53.4%). ASU model had a shorter time to theatre (WMD: -0.40, 95% CI: -0.65 to 0.15, p: 0.002), length of hospital stay (WMD: -0.25, 95% CI: -0.46 to -0.05, p: 0.02) and complication rate (OR: 0.76, 95% CI: 0.59 to 0.99, p: 0.04) for appendectomy patients. ASU model did not significantly affect night time operating (OR: 1.04, 95% CI: 0.66 to 1.65, p: 0.86) negative appendectomy rates (OR: 0.98, 95% CI: 0.77-1.27, p: 0.91) or conversion rate (OR: 1.45, 95% CI: 0.70 to 2.98, p: 0.32). CONCLUSION: ASU model improves outcomes and quality of care in patients undergoing emergency appendectomy without any adverse implications.
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Balasubramanian et al. (2018) conducted a meta-analysis in appendectomy (n=7,980). Acute surgical unit (ASU) model vs. Traditional (TRAD) model was evaluated on complication rate (OR 0.76, 95% CI 0.59 to 0.99, p=0.04). The acute surgical unit model for appendectomy significantly reduced complication rates (OR 0.76; 95% CI 0.59-0.99; P=0.04) and shortened time to theatre compared to traditional models.
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