Efficiency of care and cost for common emergency general surgery conditions: Comparison by surgeon training and practice

Background: Our institutional emergency general surgery service is staffed by both trauma and critical care–trained surgeons and other boarded general surgeons and subspecialists. We compared efficiency of care for common emergency general surgery conditions between trauma and critical care–trained surgeons and boarded general surgeons and subspecialists. Methods: Adults admitted between February 2014 and May 2017 with acute appendicitis, acute cholecystitis, intestinal obstruction, incarcerated hernia, or other acute abdominal diagnoses seen by emergency general surgery service were included. Demographic characteristics, consulting surgeon, operations, outcomes, and cost data were obtained. Results: A total of 1,363 patients were included: 384 (28.2%) with acute appendicitis, 477 (35.0%) with acute cholecystitis, 406 (29.8%) with intestinal obstruction, 22 (1.6%) with incarcerated hernia, and 74 (5.4%) with other acute abdominal diagnoses. Trauma and critical care–trained surgeons saw 836 (61.3%) patients. There was no difference in operative management between the two groups, however, trauma and critical care–trained surgeons had significantly less time to the operative room (7.0 vs 12.9 hours; P <.001), without a difference in duration of stay or costs. The subgroups of acute appendicitis and acute cholecystitis when treated by trauma and critical care–trained surgeons had less time to the operative room (8.4 vs 17.4 hours; P <.001), shorter hospital stay (2.5 vs 2.8 days; P =.021), and less emergency department cost ($822 vs $876; P =.012). Conclusion: Compared with boarded general surgeons and subspecialists, trauma and critical care–trained surgeons provide more efficient care for common emergency general surgery conditions, with less time from consultation to the operative room.