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BACKGROUND: Emergency surgical ambulatory care provides safe and effective assessment of acute surgical referrals, in addition to reducing the pressures on hospital beds.Our aim was to look at the effect of opening a surgical ambulatory care unit (SACU) and a dedicated surgeon for the unit on length of stay and same day discharge for emergency referrals. METHODS: Data was collected prospectively and updated daily to include all referrals to SACU. Historical data was retrieved to compare the effect of introduction of SACU and dedicated surgeon on same day discharge and length of stay. RESULTS: Three groups of patients were identified: pre-SACU, SACU and SACU with dedicated surgeon. There was 104.5% percentage increase in same day discharge rate for emergency GP referrals (22% pre-SACU to 45% in the dedicated surgeon group). Similarly, same day discharge for all emergency referrals increased from 17% pre-SACU to 29% in the dedicated surgeon group.There was 25.88â¯h reduction in the mean length of stay for emergency GP admissions (92.95â¯h pre-SACU to 67.07â¯h in the dedicated surgeon group). In pre-SACU group mean length of stay for all emergency admissions was 125â¯h, this dropped to 107.09â¯h in the dedicated surgeon group. This resulted in 102 hospital bed stays saved every month since the opening of SACU. CONCLUSIONS: Establishing an emergency surgical ambulatory service has reduced length of stay and saved significant hospital bed stays. This effect was enhanced by having a dedicated senior surgeon providing early input and decision making.
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AIMS: To externally validate the MSKCC nomogram in a UK population, and determine if it could be used in our practice here in the UK. METHODS: The colon cancer database from a district general hospital in England was used to extract all patients who had a curative colon cancer resection. Inclusion criteria were all patients who had curative elective colon cancer resection between 01/01/1998 and 31/12/2003. Patients were followed up for up to ten years. Five and ten year predictions were calculated for each patient, and plotted against the actual recurrence using a ROC curve, and AUC was calculated for both the five and ten year nomogram. RESULTS: 138 patients were included in the study. Overall five year recurrence rate was 26.8% with a mean follow up of 60.24 months (SD = 38.6). 118 patients were included in the five year nomogram validation, and 102 patients were included in the ten year nomogram validation. A ROC curve was plotted for both the five and ten year nomogram and AUC was calculated. For the five year nomogram AUC was 0.673, and for the ten year nomogram AUC was 0.687. Two cut off points were identified for each nomogram and this divided the cohort into low, medium and high risk groups for recurrence. Cox regression showed there was significant difference between all groups for both nomograms. CONCLUSION: The MSKCC colon cancer nomogram was validated in our cohort, but it is recommended to be used in conjunction with AJCC TNM staging system.