Acute Care Surgery Service Is Essential During a Nonsurgical Catastrophic Event, the COVID-19 Pandemic

Background The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. Methods A retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared. Results Trauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% ( P = .99) for all critically ill patients; and 13.9% vs. 27.4% ( P = .12) for COVID-19 critically ill patients. Conclusion Acute care surgery is an “essential” service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services.

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Surgeons in surge — the versatility of the acute care surgeon: outcomes of COVID-19 ICU patients in a community hospital where all ICU patients are managed by surgical intensivists

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000557 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000557

Author(s):

Rachel Leah Choron ◽

Christopher A Butts ◽

Christopher Bargoud ◽

Nicole Krumrei ◽

Amanda L Teichman ◽

...

Keyword(s):

Critically Ill ◽

Acute Care ◽

Critically Ill Patients ◽

Community Hospital ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Acute Care Surgery ◽

Icu Patients ◽

Care Surgery

BackgroundReported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division.MethodsThis was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded.ResultsOne hundred and twenty patients were included (median age 64 years (range 25–89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients.ConclusionsThis is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis.Level of evidenceLevel V.

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Organization of faculty practice and resident training in acute care surgery in an academic medical center

Surgery ◽

10.1016/j.surg.2007.01.005 ◽

2007 ◽

Vol 141 (3) ◽

pp. 302-303 ◽

Cited By ~ 4

Author(s):

Richard L. Gamelli

Keyword(s):

Acute Care ◽

Medical Center ◽

Academic Medical Center ◽

Resident Training ◽

Acute Care Surgery ◽

Academic Medical ◽

Care Surgery

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Fast Track Pathway for Acute Care Surgery at an Academic Medical Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.1032 ◽

2019 ◽

Vol 229 (4) ◽

pp. e115

Author(s):

Amanda Fazzalari ◽

Shruthi Srinivas ◽

Natalie Pozzi ◽

Reeti Sheoran ◽

Joseph Sabato ◽

...

Keyword(s):

Acute Care ◽

Fast Track ◽

Medical Center ◽

Academic Medical Center ◽

Acute Care Surgery ◽

Academic Medical ◽

Care Surgery

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Acute Care Surgery Program At An Academic Medical Center

Journal of Surgical Research ◽

10.1016/j.jss.2010.11.244 ◽

2011 ◽

Vol 165 (2) ◽

pp. 332

Author(s):

M. Georgiades ◽

A. Schwartzman ◽

B. Stahura ◽

M. Zenilman

Keyword(s):

Acute Care ◽

Medical Center ◽

Academic Medical Center ◽

Acute Care Surgery ◽

Academic Medical ◽

Care Surgery

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Pragmatic Disease-Focused Checklist for Use During Rounding on Critically Ill Patients With COVID-19

American Journal of Critical Care ◽

10.4037/ajcc2021697 ◽

2021 ◽

pp. e1-e5

Author(s):

Somnath Bose ◽

Akiva Leibowitz

Keyword(s):

Critically Ill ◽

Family Communication ◽

Critically Ill Patients ◽

Inflammatory Markers ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Ventilation Strategies ◽

Novel Coronavirus ◽

Existing Structure

The sudden surge in cases of novel coronavirus disease 2019 (COVID-19) has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Among the respondents, 82% were in favor of a disease-focused checklist. Mechanical ventilation parameters, rescue ventilation strategies, sedation regimens, inflammatory markers specific to COVID-19, and family communication were the elements most commonly identified as being important for inclusion in such a checklist.

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Evaluation of the Safety and Efficacy of Metformin Use in Hospitalized, Non–Critically Ill Patients

Journal of Pharmacy Technology ◽

10.1177/8755122520911689 ◽

2020 ◽

Vol 36 (3) ◽

pp. 102-109

Author(s):

Tahnia Alauddin ◽

Sarah E. Petite

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Medical Center ◽

Academic Medical Center ◽

Kidney Injury ◽

Hospitalized Patients ◽

Adverse Outcomes ◽

Safety And Efficacy ◽

Antihyperglycemic Therapy ◽

Heart Failure Diagnosis

Background: Contraindications and precautions to metformin have limited inpatient use, and limited evidence exists evaluating metformin in hospitalized patients. Objective: This study aimed to determine the safety and efficacy of inpatient metformin use. Methods: This study was an observational, retrospective, cohort study at an academic medical center between June 1, 2016, and May 31, 2018. Hospitalized adults with type 2 diabetes mellitus receiving at least 1 metformin dose were included. The primary endpoint was to identify hospitalized patients using metformin with at least 1 contraindication or precautionary warning against use. Secondary endpoints included assessing metformin efficacy with glycemic control, characterizing adverse outcomes of inpatient metformin, and comparing the efficacy of metformin-containing regimens. Results: Two hundred patients were included. There were 126 incidences of potentially unsafe use identified in 111 patients (55.5%). The most common reasons were age ≥65 years (47%), heart failure diagnosis (7.5%), and metformin within 48 hours of contrast (6%). Metformin was contraindicated in 2 patients (1%) with an estimated glomerular filtration rate ≤30 mL/min/1.73 m2. The overall median daily blood glucose was 146 mg/dL (interquartile range [IQR] = 122-181). Patients were divided into 3 groups: metformin monotherapy, metformin plus oral antihyperglycemic therapy, and metformin plus insulin. The median daily blood glucoses were 129 mg/dL (IQR = 110-152), 154 mg/dL (IQR = 133-178), and 174 mg/dL (IQR = 142-203; P < .001), respectively. Two patients (1%) developed acute kidney injury, and no patients developed lactic acidosis. Conclusions: Metformin was associated with goal glycemic levels in hospitalized patients with no adverse outcomes. These results suggest the potential for metformin use in hospitalized, non–critically ill patients.

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Acute Care Surgery: Defining Mortality in Emergency General Surgery in the State of Maryland

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.12.051 ◽

2015 ◽

Vol 220 (4) ◽

pp. 762-770 ◽

Cited By ~ 15

Author(s):

Mayur Narayan ◽

Ronald Tesoriero ◽

Brandon R. Bruns ◽

Elena N. Klyushnenkova ◽

Hegang Chen ◽

...

Keyword(s):

Acute Care ◽

General Surgery ◽

The State ◽

Acute Care Surgery ◽

Emergency General Surgery ◽

Care Surgery

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Macroeconomic trends and practice models impacting acute care surgery

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000295 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000295 ◽

Cited By ~ 5

Author(s):

Andrew Bernard ◽

Kristan Staudenmayer ◽

Joseph P Minei ◽

Jay Doucet ◽

Adil Haider ◽

...

Keyword(s):

Critical Care ◽

Acute Care ◽

Elective Surgery ◽

Care Delivery ◽

Acute Care Surgery ◽

Healthcare Organizations ◽

Emergency General Surgery ◽

Case Volume ◽

Practice Models ◽

Care Surgery

Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA.

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