LAUSR

INTRODUCTION Timely access to the operating room (OR) for emergency general surgery (EGS) diseases is key to optimizing outcomes. We conducted a national survey on EGS structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared to a traditional general surgeon on call (GSOC) approach. STUDY DESIGN We surveyed 2,811 acute care general hospitals in the US capable of EGS care. The questionnaire included queries regarding structures and processes related to OR access and on the model of EGS care (ACS vs GSOC). Associations between the EGS care model and structures and processes to ensure OR access were measured using univariate and multivariate models (adjusted for hospital characteristics). RESULTS Of 1,690 survey respondents (60.1%), 1497 reported ACS or GSOC. 272 (18.2%) utilized an ACS model. ACS hospitals were more likely to have >5 days of block time and a tiered system of booking urgent/emergent cases compared to GSOC hospitals (34.2% vs 7.4% and 85.3% vs 57.6%, respectively; all p-values <0.001). Surgeons at ACS hospitals were more likely to be free of competing clinical duties, be in-house overnight, and cover at a single hospital overnight when covering EGS (40.1% vs 4.7%, 64.7% vs 25.6%, and 84.9% vs 64.9%, respectively; all p-values <0.001). ACS hospitals were more likely to have overnight in-house scrub techs, OR nurses and recovery room nurses (69.9% vs 13.8%, 70.6% vs. 13.9%, and 45.6% vs 5.4%, respectively; all p-values <0.001). On multivariable analysis, ACS hospitals had higher odds of all structures and processes that would improve OR access. CONCLUSIONS ACS implementation is associated with factors that may improve OR access. This finding has implications for potential expansion of EGS care models that ensure prompt OR access for the EGS diseases that warrant emergency surgery. LEVEL OF EVIDENCE III, Therapeutic.