AB056. SOH22ABS064. Selected emergency admissions under General Surgery: who are best treated in hospital?

Background: Bed capacity issues have led to increasing strain on inpatient surgical care in Irish Hospitals. Population analysis identifies approximately 56% of acute general surgical admissions never require surgery during their stay. Who are these patients? Are they best suited to ambulatory, community or other disciplinary care?

Methods: Hospital level data is required to identify the disease related groupings of these non-operated acute patients. Hospital In-Patient Enquiry discharge data was analysed from January 2019 through to May 2021 for patients admitted emergently under general surgery in a Model 4 Hospital. Primary outcomes studied were diagnoses of patients not requiring an operation, endoscopy or interventional radiology procedure. Age, sex, length of stay, type of operative and non-operative management were secondarily studied.

Results: Of 4,576 patients admitted during the study period, 3,050 (67%) of these patients did not undergo a formal knife to skin operation. Two thousand two hundred and sixteen (48.4%) of these did not undergo an endoscopic or radiological procedure either. Non-operative patients stayed a shorter time in hospital (mean 5.5 vs. 10.8; P<0.001). This was made up of 497 (22.4%) patients with presentations of abdominal pain discharged within 48 hours and 219 (9.9%) with cellulitis. These groups represented 2,043 bed days, 1,321 of which were for cellulitis.

Conclusions: There were 716 (32.3%) patients who didn’t undergo procedural intervention. This includes cellulitis and short stay admissions (less than 48 hours) with abdominal pain, including mild diverticulitis, cholecystitis and pancreatitis, which represent targets for ambulatory and community based care freeing up 5.8% of acute surgical in-patient bed days per year in one institution.

Keywords: Acute surgery; admission; ambulatory care; length of stay; non-operative management