A day in the life of emergency general surgery in Canada: a multicentre observational study

A day in the life of emergency general surgery in Canada: a multicentre observational study

Can J Surg 2018;61(4):237-243| PDF | Appendix

Kristin DeGirolamo, MD; Karan D’Souza, BSc; Sameer Apte, MD; Chad G. Ball, MD; Christopher Armstrong, MD; Artan Reso, MD; Sandy Widder, MD; Sarah Mueller, MD; Lawrence M. Gillman, MD; Ravinder Singh, MD; Rahima Nenshi, MD; Kosar Khwaja, MD; Samuel Minor, MD; Chris de Gara, MB, MS; S. Morad Hameed, MD

Abstract

Background: Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services’ structure, processes, case mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population.

Methods: A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected.

Results: Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]).

Conclusion: The characteristics and case mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.

Résumé

Contexte : Les services de chirurgie générale d’urgence (CGU) gagnent en popularité au Canada en tant qu’approches systémiques aux urgences chirurgicales. Malgré le volume élevé, le caractère urgent et la complexité des populations de patients desservies en CGU, peu de rapports ont porté sur la structure, les processus, les clientèles ou les résultats de ces services. La présente étude instaure une démarche de surveillance nationale qui servira à définir et à améliorer la qualité des chirurgies destinées à cette population importante et hétérogène.
Méthodes : Une étude transversale nationale sur les services de CGU a été réalisée sur une période de 24 heures en janvier 2017 dans 14 hôpitaux de 7 provinces canadiennes recrutés par l’entremise du comité pour les soins aigus de l’Association canadienne des chirurgiens généraux. On y a inclus les patients admis dans les services de CGU, les nouvelles consultations et les patients de l’extérieur suivis par les services de CGU pendant la période de l’étude. On a recueilli les caractéristiques démographiques des patients et les données sur les interventions, les procédures et les complications.

Résultats : Douze sites ont fait état de la couverture assurée par les résidents. La plupart des services ont exclu la traumatologie. Dix sites disposaient de temps protégé au bloc opératoire. En tout, 393 rencontres avec des patients ont eu lieu pendant la période de l’étude (195/386 [50,4 %] chirurgicales, 191/386 [49,5 %] non chirurgicales), avec une moyenne de 3,8 chirurgies par service. La population regroupait des cas complexes : 136 patients (34,6 %) présentaient plus de 3 comorbidités. La clientèle était diversifiée et comprenait des cas de maladie de la vésicule biliaire (69 cas [17,8 %]) et de l’appendice (31 [8,0 %]), de même que des situations d’urgence délicates, telle qu’obstruction (56 [14,5 %]) et perforation (23 [5,9 %]).

Conclusion : Leurs caractéristiques et leurs clientèles sont hétérogènes, mais les services de CGU sont tous achalandés et ils offrent tous des soins chirurgicaux et non chirurgicaux complets à des patients gravement malades porteurs d’importantes comorbidités.


Accepted Nov. 17, 2017; Published online June 1, 2018

Acknowledgements: The authors thank the Canadian Association of General Surgeons Acute Care Committee for participating in this study and volunteering their hospital data and research staff to help make this project possible. The authors acknowledge Jillian Aquino for her design and creation of the figure.

Affiliations: From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D’Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed).

Competing interests: None declared.

Contributors: K. DeGirolamo, K. D’Souza, S. Apte, C.G. Ball and S.M. Hameed designed the study. All authors acquired the data, which K. DeGirolamo, K. D’Souza, S. Apte, C.G. Ball and S.M. Hameed analyzed. K. DeGirolamo, K. D’Souza, S. Apte, C.G. Ball and S.M. Hameed wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.013517

Correspondence to: M. Hameed, Trauma Services, Vancouver General Hospital, 855 West 12th Ave, Vancouver BC V5Z 1M9, morad.hameed@vch.ca