Skip to main content


Log in

Logistical factors associated with adverse outcomes following emergency surgery in an acute care surgical unit

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript



The Acute Care Surgical Unit at Groote Schuur Hospital was established in 2010 and is the first of its kind in Africa. The aim of this study was to describe the outcomes of emergency surgical cases, as well as determine the logistical factors associated with adverse outcomes following surgery within the unit.


This study was a retrospective audit which reviewed the folders of adult patients who underwent an emergency surgical procedure from July 2016 to July 2017. The primary outcome was a major adverse event (AE) which was defined by a Clavien–Dindo score of 3–5. A number of logistical factors related to patient admission and operation were evaluated for association with outcomes.


A total of 271 patients were included with a mean age of 47 years, with 48% females and 52% males. A major AE was recorded for 13% of patients. The following factors were found to be predictive of a major AE: referral from outside the hospital, urgent booking colour code, reoperation, and consultant most senior surgeon present during procedure. Patient admission/surgery performed outside of normal working hours, being booked for surgery on admission, as well as delay to surgery beyond colour code were not associated with a major AE.


Apart from the traditional clinical parameters, factors related to perioperative logistics may contribute to the risk of a major AE after emergency surgery and should be considered for inclusion in more comprehensive predictive models for adverse outcomes within an acute care surgery unit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Stitzenberg KB, Sheldon GF. Progressive specialization within general surgery: adding to the complexity of workforce planning. J Am Coll Surg. 2005;6:925–32.

    Article  Google Scholar 

  2. Cubas RF, Gómez NR, Rodriguez S, Wanis M, Sivanandam A, Garberoglio CA. 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;5:715–21.

    Article  Google Scholar 

  3. Hoyt DB, Kim HD, Barrios C. Acute care surgery: a new training and practice model in the United States. World J Surg. 2008;8:1630–5.

    Article  Google Scholar 

  4. Lau B, DiFronzo LA. An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis. Am Surg. 2011;10:1318–21.

    Google Scholar 

  5. Schaetzel S, Dirks R, Davis J. Comparison of outcomes of patients with acute appendicitis between an acute care surgery model and traditional call coverage model in the same community. Am J Surg. 2016;6:1083–9.

    Article  Google Scholar 

  6. Gandy RC, Truskett PG, Wong SW, Smith S, Bennett MH, Parasyn AD. Outcomes of appendicectomy in an acute care surgery model. Med J Aust. 2010;5:281–4.

    Article  Google Scholar 

  7. Fu CY, Huang HC, Chen RJ, Tsuo HC, Tung HJ. Implementation of the acute care surgery model provides benefits in the surgical treatment of the acute appendicitis. Am J Surg. 2014;5:794–9.

    Article  Google Scholar 

  8. Von Conrady D, Hamza S, Weber D, Kalani K, Epari K, Wallace M, Fletcher D. The acute surgical unit: improving emergency care. ANZ J Surg. 2010;12:933–6.

    Article  Google Scholar 

  9. 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;6:1381–7.

    Article  Google Scholar 

  10. Page DE, Dooreemeah D, Thiruchelvam D. Acute surgical unit: the Australasian experience. ANZ J Surg. 2014;1–2:25–30.

    Article  Google Scholar 

  11. Koea JB, Srinivasa S, Hundal H. Provision of acute general surgery: a systematic review of models of care. J Trauma Acute Care Surg. 2014;1:219–25.

    Article  Google Scholar 

  12. Sudarshan M, Feldman LS, Louis ES, Al-Habboubi M, Hassan MM, Fata P, Deckelbaum DL, Razek TS, Khwaja KA. Predictors of mortality and morbidity for acute care surgery patients. J Surg Res. 2015;2:868–73.

    Article  Google Scholar 

  13. Mentula PJ, Leppäniemi AK. Applicability of the Clavien–Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients. Patient Saf Surg. 2014;1:31.

    Article  Google Scholar 

  14. Elshove-Bolk J, Ellensen VS, Baatrup G. Logistics and outcome in urgent and emergency colorectal surgery. Colorectal Dis. 2010;12:e255-9.

    Article  Google Scholar 

  15. Khan S, Zafar H, Zafar SN, Haroon N. Inter-facility transfer of surgical emergencies in a developing country: effects on management and surgical outcomes. World J Surg. 2014;2:281–6.

    Article  Google Scholar 

  16. Klopper JH, Rayamajhi S, Venter JJ, De Villiers DJ, Almgla N, Kloppers JC. Provision of acute and elective general surgical care at a tertiary facility in the era of subspecialisation. S Afr Med J. 2017;11:948–51.

    Article  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;2:187–96.

    Article  Google Scholar 

  18. Spence RT, Hampton M, Pluke K, Kahn M, Chinyepi N, Elmusbahi M, van Wyngaard T, Panieri E. Factors associated with adverse events after emergency laparotomy in Cape Town, South Africa: identifying opportunities for quality improvement. J Surg Res. 2016;2:363–70.

    Article  Google Scholar 

  19. Aloia TA, Cooper A, Shi W, Vauthey JN, Lee JE. Reoperative surgery: a critical risk factor for complications inadequately captured by operative reporting and coding of lysis of adhesions. J Am Coll Surg. 2014;1:143–50.

    Article  Google Scholar 

  20. Shakerian R, Thomson BN, Gorelik A, Hayes IP, Skandarajah AR. Outcomes in emergency general surgery following the introduction of a consultant-led unit. Br J Surg. 2015;13:1726–32.

    Article  Google Scholar 

  21. Casadei R, Ricci C, Pezzilli R, Calculli L, D’Ambra M, Taffurelli G, Minni F. Assessment of complications according to the Clavien–Dindo classification after distal pancreatectomy. J Pancreas. 2011;2:126–30.

    Google Scholar 

Download references


The authors wish to thank Dr Richard Spence for his advice on the manuscript preparation.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Daniel Nel.

Ethics declarations

Conflict of interest

Daniel Nel, Christo Kloppers, Shreya Rayamajhi, and Juan Klopper declare that they have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nel, D., Kloppers, C., Rayamajhi, S. et al. Logistical factors associated with adverse outcomes following emergency surgery in an acute care surgical unit. Eur J Trauma Emerg Surg 46, 377–382 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: