The Effects of the ACS 7th Surgeon on Emergency General Surgery Patient Outcomes

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Acute Care Surgery (ACS) models have been adopted by hospitals across North America as a method to improve timeliness of care for patients in need of emergency surgery. Multiple benefits for patients and hospitals have been associated with this model, including less time to surgery and decreased total length of hospital stay. However, the operative volume on the Emergency General Surgery (EGS) service at Butterworth Hospital is staggering, which leaves the attending surgeon without sufficient time to round on patients and evaluate consults in the ED. To address this issue, the "7th Surgeon" was employed in November of 2023 to assist EGS and other ACS services with rounding, consult evaluation, and clinic duties. This study was designed to determine if the addition of the 7th Surgeon has enhanced the outcomes for EGS patients at Butterworth Hospital.

This was a retrospective cohort study that evaluated patient outcomes in the years prior to and following the addition of the 7th surgeon role in November of 2023. The pre-intervention group was composed of patients from 10/1/22 to the morning of 11/1/23. The post-intervention cohort began the next month to allow for an adjustment period; this cohort included patients from 12/1/23 to 12/31/24. The Michigan Acute Care Surgery registry was queried to identify all adult patients admitted to Butterworth EGS during these time periods. Data was obtained from the registry and via direct chart review. The primary objective was to assess differences in time from ED consult to surgery between cohorts. The secondary objective was to determine potential changes in adverse events. Numeric outcomes were expressed as mean ± standard deviation, and categorical outcomes were expressed as percentages.

2,109 patients were included in the study; 986 were admitted prior to initiation of the 7th Surgeon, while 1,123 were in the post-intervention cohort, an increase of 13.9%. Regarding the primary outcome, the time from ED consultation to the start of the first surgery was 12.80 hr (SD ± 15.86) in the pre-intervention cohort and 13.66 hr (SD ± 17.69) in the post-intervention cohort. The rates of sepsis (3.56% vs. 3.04%), VTEs (0.80% vs. 0.30%), unplanned ICU admission (3.41% vs. 1.93%), and patients discharged as deceased or with hospice (0.98% vs. 0.61%) were all greater following the addition of the 7th surgeon. There were no notable differences in the rates of CAUTI or CLABSI.

In this study, the mean time from ED consultation to the start of the first surgery was longer in the period after implementation of the 7th Surgeon; however, potential confounders exist such as the increase in patient volume and the introduction of new techniques such as robotic-assisted surgery. Furthermore, the small increases in adverse in-hospital events may be related to the 13.9% increase in EGS admissions during the same timeframe. Future studies should identify potential improvements in time to consult evaluation and hospital readmissions.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2138

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