The Successful Implementation of a Trauma and Acute Care Surgery Model in Ecuador

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2020 Feb 29

PMID 32107595

Citations 6

Authors

Doris Sarmiento Altamirano

Amber Himmler

Oscar Chango Siguenza

Raul Pino Andrade

Nube Flores Lazo

Jeovanni Reinoso Naranjo

Hernan Sacoto Aguilar

Lenin Fernandez de Cordova

Edgar Rodas

Juan Carlos Puyana

Juan Carlos Salamea Molina

Affiliations

Soon will be listed here.

Abstract

Background: For years, surgical emergencies in Ecuador were managed on a case-by-case basis without significant standardization. To address these issues, the Regional Hospital Vicente Corral Moscoso adapted and implemented a model of "trauma and acute care surgery" (TACS) to the reality of Cuenca, Ecuador.

Methods: A cohort study was carried out, comparing patients exposed to the traditional model and patients exposed to the TACS model. Variables assessed included number of surgical patients attended to in the emergency department, number of surgical interventions, number of surgeries performed per surgeon, surgical wait time, length of stay and in-hospital mortality.

Results: The total number of surgical interventions increased (3919.6-5745.8, p ≤ 0.05); by extension, the total number of surgeries performed per surgeon also increased (5.37-223.68, p ≤ 0.05). We observed a statistically significant decrease in surgical wait time (10.6-3.2 h for emergency general surgery, 6.3-1.6 h for trauma, p ≤ 0.05). Length of stay decreased in trauma patients (9-6 days, p ≤ 0.05). Higher mortality was found in the traditional model (p ≤ 0.05) compared to the TACS model.

Conclusions: The implementation of TACS model in a resource-restrained hospital in Latin America had a positive impact by decreasing surgical waiting time in trauma and emergency surgery patients and length of stay in trauma patients. We also noted a statistically significant decrease in mortality. Savings to the overall system and patients can be inferred by decreased mortality, length of stay and surgical wait times. To our knowledge, this is the first implementation of a TACS model described in Latin America.

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