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Background: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Methods: In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged. Readmissions during the 30-day window were also captured. Preoperative, intraoperative and postoperative variables were tracked. Standard statistical methodology was employed. Results: A total of 601 ACS/EGS patients were followed for up to 30 inpatient or readmission days after their index emergent operation. Fifty-one percent of patients were female, and the median age was 51 years. They frequently had substantial medical comorbidities (42%) and morbid obesity (15%). The majority of procedures were minimally invasive (66% laparoscopic). Median length of stay was 3.3 days and the early readmission (< 30 d) rate was 6%. Six percent of patients were admitted to the critical care unit. The overall complication and mortality rates were 34% and 2%, respectively. Cholecystitis (31%), appendicitis (21%), bowel obstruction (18%), incarcerated hernia (12%), gastrointestinal hemorrhage (7%) and soft tissue infections (7%) were the most common diagnoses. The morbidity and mortality rates for open surgical procedures were 73% and 5%, respectively. Conclusion: Nontrauma ACS/EGS procedures are associated with a high postoperative morbidity rate. This study will serve as a prospective benchmark for postoperative complications among ACS/EGS patients and subsequent quality improvement across Canada. Contexte : Les services de chirurgie dans les unites de soins actifs (CSA) et de chirurgie generale dans les services d'urgence (CGSU) doivent fournir rapidement des soins et des interventions a des patients dont les besoins sont parmi les plus complexes. En effet, les patients pris en charge par les services de CSA sont souvent gravement malades et presentent des comorbidites sur fond de faible reserve physiologique. Meme si les services de CSA/CGSU se sont repandus en Amerique du Nord, les taux reels de morbidite postoperatoire demeurent pour une bonne part inconnus. Methodes : Dans cette etude prospective, on a suivi pendant 30 jours ou jusqu'a leur conge, les patients hospitalises pour des interventions chirurgicales dans 8 centres de CSA/CGSU achalandes de divers endroits au Canada. On a egalement tenu compte des readmissions dans les 30 jours. Les parametres pre-, per- et postoperatoires ont ete enregis tres. Une methodologie statistique standard a ete appliquee. Resultats : En tout, 601 patients de CSA/CGSU ont ainsi ete suivis pendant une duree allant jusqu'a 30 jours d'hospitalisation ou de readmission apres leur intervention urgente initiale. Cinquante et un pour cent etaient de sexe feminin et l'age moyen etait de 51 ans. Ces patients etaient nombreux a presenter des comorbidites de nature medicale substantielles (42 %) et une obesite morbide (15 %). La majorite des interventions ont ete minimalement effractives (66 % laparoscopiques). La duree mediane des sejours a ete de 3,3 jours et le taux de readmission precoce (< 30 j) a ete de 6 %. Six pour cent des patients ont ete admis aux soins intensifs. Les taux globaux de complications et de mortalite ont ete respectivement de 34 % et de 2 %. Cholecystite (31 %), appendicite (21 %), obstruction intestinale (18 %), hernie incarceree (12 %), hemorragie digestive (7 %) et infections des tissus mous (7 %) comptent parmi les diagnostics les plus frequents. Les taux de morbidite et de mortalite dans les cas de chirurgies ouvertes ont ete respectivement de 73 % et 5 %. Conclusion : Les interventions de CSA/CGSU non liees a la traumatologie sont associees a un taux de morbidite postoperatoire eleve. Cette etude fournira un ensemble de valeurs de references pour l'etude prospective des complications chez les patients pris en charge par les services de CSA/CGSU et l'amelioration subsequente des soins partout au Canada., It is clear to every surgeon working in acute care surgery (ACS) and emergency general surgery (EGS) that timely and complex surgical care is required to achieve optimal outcomes for [...]

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Lifestyle has been identified by numerous studies as the number one deterrent to pursuing a career in general surgery. This study tests the hypothesis that a better lifestyle during general surgery clerkship correlates with a higher application rate to general surgery. Canadian Residency Matching Service data from the past 10 years were used to identify institution-specific application rates to general surgery. Through a survey of all fourth-year medical students applying to general surgery in Canada and Canadian undergraduate surgery program directors, the lifestyle of each general surgery clerkship was described and given a score. Multiple descriptions of the clerkship structure were obtained for every school in Canada to reduce recall bias, with an average of 4 sources per program. One school stood out as the most prolific producer of general surgery applicants, with an average of 7.9% of the total class applying to general surgery each year. This represented 80% more general surgery applicants relative to the national average ( p < 0.05). Surprisingly, however, this institution also had the worst clerkship lifestyle score, having a higher call requirement, not sending their clerks home at noon post call, and placing a higher burden of responsibility on their clerks. This study suggests that a lifestyle-friendly surgical clerkship may not be necessary to increase recruitment into general surgery. [ABSTRACT FROM AUTHOR]