• Mazhar Khalil, Viraj Pandit, Peter Rhee, Narong Kulvatunyou, Tahereh Orouji, Andrew Tang, Terence O'Keeffe, Lynn Gries, Gary Vercruysse, Randall S Friese, and Bellal Joseph.
• From the Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, The University of Arizona, Tucson, Arizona.
• J Trauma Acute Care Surg. 2015 Jul 1;79(1):60-3; discussion 64.

BackgroundDifferences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC).MethodsNational estimates for EGS procedures were abstracted from the National Inpatient Sample database. Patients undergoing emergent procedures (appendectomy, cholecystectomy, hernia repair, as well as small and large bowel resections) were included. TCs were identified based on American College of Surgeons' verification. ACS-TC programs were recorded from the American Association for the Surgery of Trauma. Outcome measures were hospital length of stay, complications, and mortality. Regression analysis was performed after adjusting for age, sex, race, Charlson comorbidity index, and type of procedure.ResultsA total of 131,410 patients undergoing EGS were analyzed. Patients managed in ACS-TCs had shorter hospital stay (p = 0.045) and lower complication rate (p = 0.041) compared with patients managed in both TCs and NTCs. There was no difference in mortality in patients managed across the groups; however, there was a trend toward lower mortality in patients managed in ACS-TCs in comparison with TCs (p = 0.064) and NTCs (p = 0.089). The overall hospital costs were lower for patients managed in ACS-TCs compared with TCs (p = 0.036).ConclusionTCs with ACS have improved outcomes in EGS procedures compared with both TCs and non-TCs. ACS training with the associated infrastructure standards may contribute to these improved outcomes.Level Of EvidenceTherapeutic/care management study, level IV.

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