The rise of ACS and its importance

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. 1)

   Exposed to a wide variety of operative procedures and techniques, including the latest laparoscopic and robotic skill sets .

2. 2)

   The trauma surgeon will get a high operative load weekly, if not daily, to remain fresh and sharp.

3. 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.

1. 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

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

1. Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, S169608, Singapore

   Brian WCA Tian

Authors

1. 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:

Get shareable link

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

Copy to clipboard

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

• Acute care
• Trauma
• Health systems