The rise of ACS and its importance,World Journal of Emergency Surgery

当前位置： X-MOL 学术 › World J. Emerg. Surg. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

The rise of ACS and its importance
World Journal of Emergency Surgery ( IF 6.0 ) Pub Date : 2024-03-08 , DOI: 10.1186/s13017-024-00538-7
Brian WCA Tian

Acute care surgery [ACS] as a model of care and a focused area of specialisation is gaining traction globally [1,2,3]. ACS is seen as a natural evolution of the specialty of trauma. If anything, this restructuring is desperately needed.

In the ideal ACS system, I propose that surgeons will be:

1)
Exposed to a wide variety of operative procedures and techniques, including the latest laparoscopic and robotic skill sets .
2)
The trauma surgeon will get a high operative load weekly, if not daily, to remain fresh and sharp.
3)
The ACS surgeon should constantly advance research and development in emergency work, which is often neglected [4].

Globally, every country runs its own version of the ACS model. Despite the variation in systems, the ACS model has generally been shown to reduce time to surgery and complication rates, particularly for common conditions such as appendicitis and cholecystitis [5,6,7]. The productivity of the department as a whole also improves, with greater utilisation of the theatre and intensive care unit (ICU) [8]. Some studies reported reductions in length of stay (LOS), complications and costs compared to those in standard care units [9, 10]. Apart from patient driven outcomes, some studies have also shown improvements in inhouse operative teaching, and greater consultant presence in the theatre [11].

To date, there has yet to be a universal gold standard as to how to run the ACS system. Although ACS is beginning to show positive results from a systems and workflow point of view; its future is uncertain.

It is therefore imperative to gain insights into ACS systems round the world, to form the basis for learning and comparison. This will ultimately bring the global community together, and will eventually help to foster the development of a universal gold standard system.

Stawicki SP, Brooks A, Bilski J, et al. The concept of damage control: extending the paradigm to emergency general surgery. Injury. 2008;39:93–101.
Article PubMed Google Scholar
van der Wee MJL, van der Wilden G, Hoencamp R. Acute Care surgery models Worldwide: a systematic review. World J Surg. 2020;44(8):2622–37. https://doi.org/10.1007/s00268-020-05536-9. PMID: 32377860; PMCID: PMC7326827.
Article PubMed PubMed Central Google Scholar
Hollands M. Acute care surgery and trauma: a marriage of convenience. Injury. 2008;39(1):90 – 2. https://doi.org/10.1016/j.injury.2007.11.023. PMID: 18164302.
de’Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D’Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg. 2022;17(1):4. https://doi.org/10.1186/s13017-022-00410-6. PMID: 35057836; PMCID: PMC8781145.
Article PubMed PubMed Central Google Scholar
Earley AS, Pryor JP, Kim PK, et al. An acute care surgery model improves outcomes in patients with appendicitis. Ann Surg. 2006;244:498–504.
PubMed PubMed Central Google Scholar
Cubas RF, Gómez NR, Rodriguez S, et al. Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost. J Am Coll Surg. 2012;215:715–21.
Article PubMed Google Scholar
Nagaraja V, Eslick GD, Cox MR. The acute surgical unit model verses the traditional on call model: a systematic review and meta-analysis. World J Surg. 2014;38:1381–7.
Article PubMed Google Scholar
Austin MT, Diaz JJ Jr, Feurer ID, et al. Creating an emergency general surgery service enhances the productivity of trauma surgeons, general surgeons and the hospital. J Trauma. 2005;58:906–10.
Article PubMed Google Scholar
Lehane CW, Jootun RN, Bennett M, Wong S, Truskett P. Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J Surg. 2010;80:438–42.
Article PubMed Google Scholar
Khalil M, Pandit V, Rhee P et al. Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: a nationwide analysis. J Trauma Acute Care Surg 2015; 79:60 – 3; discussion 64.
Page DE, Dooreemeah D, Thiruchelvam D. Acute surgical unit: the Australasian experience. ANZ J Surg. 2014;84:25–30.
Article PubMed Google Scholar

Download references

No.

Authors and Affiliations

Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, S169608, Singapore
Brian WCA Tian

Authors

Brian WCA TianView author publications
You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian WCA Tian.

Declarations

No.

Conflict of interest

No.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

Cite this article

Tian, B.W. The rise of ACS and its importance. World J Emerg Surg 19, 9 (2024). https://doi.org/10.1186/s13017-024-00538-7

Download citation

Received: 26 February 2024
Accepted: 29 February 2024
Published: 08 March 2024
DOI: https://doi.org/10.1186/s13017-024-00538-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

Acute care
Trauma
Health systems

中文翻译：

ACS 的兴起及其重要性

急性护理手术 [ACS] 作为护理模式和重点专业领域正在全球范围内获得关注 [1,2,3]。ACS 被视为创伤专业的自然演变。如果说有什么不同的话，那就是这种重组是迫切需要的。

在理想的 ACS 系统中，我建议外科医生将：

1）
接触各种手术程序和技术，包括最新的腹腔镜和机器人技能。
2）
创伤外科医生每周（如果不是每天）都会承受较高的手术负荷，以保持新鲜和锐利。
3）
ACS外科医生应不断推进急诊工作的研究和开发，而这往往被忽视[4]。

在全球范围内，每个国家都运行自己版本的 ACS 模型。尽管系统存在差异，但 ACS 模型通常已被证明可以减少手术时间和并发症发生率，特别是对于阑尾炎和胆囊炎等常见疾病[5,6,7]。随着手术室和重症监护病房 (ICU) 的利用率得到提高，整个部门的生产力也得到了提高 [8]。一些研究报告称，与标准护理病房相比，住院时间 (LOS)、并发症和费用都有所减少 [9, 10]。除了以患者为导向的结果外，一些研究还表明内部手术教学有所改善，并且手术室中顾问的数量也有所增加[11]。

迄今为止，对于如何运行 ACS 系统还没有一个通用的黄金标准。尽管 ACS 从系统和工作流程的角度开始显示出积极的成果；它的未来是不确定的。

因此，深入了解世界各地的 ACS 系统势在必行，为学习和比较奠定基础。这最终将使国际社会团结在一起，并最终有助于促进通用金本位体系的发展。

Stawicki SP、Brooks A、Bilski J 等人。损伤控制的概念：将范式扩展到急诊普通外科。受伤。2008；39：93-101。
文章 PubMed 谷歌学术
van der Wee MJL、van der Wilden G、Hoencamp R。全球急性护理手术模型：系统评价。世界外科杂志。2020；44(8):2622–37。https://doi.org/10.1007/s00268-020-05536-9。电话号码：32377860；PMCID：PMC7326827。
文章 PubMed PubMed Central Google Scholar
Hollands M. 急性护理手术和创伤：权宜之计。受伤。2008；39(1):90 – 2。https://doi.org/10.1016/j.injury.2007.11.023。PMID：18164302。
de'Angelis N、Khan J、Marchegiani F、Bianchi G、Aisoni F、Alberti D、Ansaloni L、Biffl W、Chiara O、Ceccarelli G、Coccolini F、Cicuttin E、D'Hondt M、Di Saverio S、Diana M、 De Simone B、Espin-Basany E、Fichtner-Feigl S、Kashuk J、Kouwenhoven E、Leppaniemi A、Beghdadi N、Memeo R、Milone M、Moore E、Peitzmann A、Pessaux P、Pikoulis M、Pisano M、Ris F、 Sartelli M、Spinoglio G、Sugrue M、Tan E、Gavriilidis P、Weber D、Kluger Y、Catena F。紧急情况下的机器人手术：2021 年 WSES 立场文件。世界紧急外科杂志。2022；17(1):4。https://doi.org/10.1186/s13017-022-00410-6。电话号码：35057836；PMCID：PMC8781145。
文章 PubMed PubMed Central Google Scholar
Earley AS、Pryor JP、Kim PK 等人。急性护理手术模型可改善阑尾炎患者的预后。安外科医生。2006；244：498-504。
PubMed PubMed 中心 Google 学术搜索
古巴 RF、戈麦斯 NR、罗德里格斯 S 等。新的急症护理手术服务模式中阑尾炎和胆囊炎的治疗结果：对时间和成本的影响。J Am Coll Surg。2012；215：715–21。
文章 PubMed 谷歌学术
Nagaraja V、Eslick GD、Cox MR。急性手术室模型与传统的待命模型：系统评价和荟萃分析。世界外科杂志。2014；38：1381–7。
文章 PubMed 谷歌学术
Austin MT、Diaz JJ Jr、Feurer ID 等。创建紧急普通外科服务可以提高创伤外科医生、普通外科医生和医院的生产力。J 创伤。2005；58：906–10。
文章 PubMed 谷歌学术
Lehane CW、Jootun RN、Bennett M、Wong S、Truskett P。急性护理手术模型是否可以改善急性胆囊炎的治疗和结果？澳新银行杂志外科杂志。2010；80：438–42。
文章 PubMed 谷歌学术
Khalil M、Pandit V、Rhee P 等人。经过认证的急症护理手术计划可改善接受紧急手术的患者的预后：一项全国性分析。创伤急症护理外科杂志，2015；79:60 – 3; 讨论 64.
Page DE、Dooreemeah D、Thiruchelvam D。急性外科病房：澳大利亚经验。澳新银行杂志外科杂志。2014；84：25–30。
文章 PubMed 谷歌学术

下载参考资料

不。

作者和单位

普通外科, 新加坡中央医院, 欧南路, 新加坡, S169608, 新加坡
布莱恩·WCA·田

作者

Brian WCA Tian查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者

通讯作者

通讯作者：Brian WCA Tian。

声明

不。

利益冲突

不。

出版商备注

施普林格·自然对于已出版的地图和机构隶属关系中的管辖权主张保持中立。

开放获取本文根据知识共享署名 4.0 国际许可证获得许可，该许可证允许以任何媒介或格式使用、共享、改编、分发和复制，只要您对原作者和来源给予适当的认可，提供知识共享许可的链接，并指出是否进行了更改。本文中的图像或其他第三方材料包含在文章的知识共享许可中，除非材料的出处中另有说明。如果文章的知识共享许可中未包含材料，并且您的预期用途不受法律法规允许或超出了允许的用途，则您需要直接获得版权所有者的许可。要查看此许可证的副本，请访问 http://creativecommons.org/licenses/by/4.0/。知识共享公共领域奉献豁免 (http://creativecommons.org/publicdomain/zero/1.0/) 适用于本文中提供的数据，除非数据的信用额度中另有说明。

转载和许可