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. 2020 Aug;44(8):2622-2637.
doi: 10.1007/s00268-020-05536-9.

Acute Care Surgery Models Worldwide: A Systematic Review

Mats J L van der Wee  1   2 , Gwendolyn van der Wilden  3   4 , Rigo Hoencamp  3   4   5   6
Affiliations

Acute Care Surgery Models Worldwide: A Systematic Review

Mats J L van der Wee et al. World J Surg. 2020 Aug.

Abstract

Background: The Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide.

Methods: A literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles.

Results: The search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care.

Conclusions: Large national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra- and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of included studies
Fig. 2
Fig. 2
Main ACS models worldwide
See this image and copyright information in PMC

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