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

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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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Funding

No grant support or funding was received for this research.

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Authors and Affiliations

  1. Facultad de Medicina, Universidad de Azuay, Cuenca, Ecuador

    Doris Sarmiento Altamirano, Hernán Sacoto Aguilar & Juan Carlos Salamea Molina

  2. Division of Surgery, Medstar Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA

    Amber Himmler

  3. University of Pittsburgh, Pittsburgh, PA, USA

    Amber Himmler

  4. Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador

    Oscar Chango Sigüenza, Raúl Pino Andrade, Nube Flores Lazo, Jeovanni Reinoso Naranjo, Hernán Sacoto Aguilar, Lenin Fernández de Córdova & Juan Carlos Salamea Molina

  5. Facultad de Medicina, Universidad de Cuenca, Cuenca, Ecuador

    Raúl Pino Andrade, Nube Flores Lazo & Jeovanni Reinoso Naranjo

  6. Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador

    Lenin Fernández de Córdova

  7. Division of Trauma and Surgery, Virginia Commonwealth University, Richmond, VA, USA

    Edgar Rodas

  8. Division of Trauma and Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Juan Carlos Puyana

Authors
  1. Doris Sarmiento Altamirano
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  11. Juan Carlos Salamea Molina
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Correspondence to Amber Himmler.

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Amber Himmler—Global Surgery Fellow, University of Pittsburgh.

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Sarmiento Altamirano, D., Himmler, A., Chango Sigüenza, O. et al. The Successful Implementation of a Trauma and Acute Care Surgery Model in Ecuador. World J Surg 44, 1736–1744 (2020). https://doi.org/10.1007/s00268-020-05435-z

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  • DOI: https://doi.org/10.1007/s00268-020-05435-z

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