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Research Collaboration

Western Ontario Research Collaborative on Acute Care Surgery
(WORC-ACS)

Composition and Mission

Since at least 2005, there has been international recognition of a newly defined field of general surgery often referred to as Acute Care Surgery (ACS). The ACS model attempts to recognize that emergency general surgery (EGS) is a unique entity that differs significantly from elective general surgery.  Indeed, EGS itself is an independent risk factor for morbidity and mortality, with EGS patients up to 5 times more likely to die than their elective surgery counterparts, a risk not fully explained by pre- or peri-operative risk factors.  Many have postulated that patients presenting with EGS conditions benefit from structured care and systems, which has, in part, led to the development and proliferation of ACS models.  Similar to the development of trauma systems throughout the world, ACS models focus on the acute care of surgical patients within the framework of a system dedicated to emergency care. In 2009, the Canadian Association of General Surgeons (CAGS) held a full-day summit to define the newly emerging model of acute care surgery, endorsing the term as the best descriptor of the initiative in Canada. There are many perceived benefits of acute care surgery models: better patient continuity, increased “patient ownership” for this historically fragmented patient population, and improved access to emergency surgical care which is thought to be better on both patient and system levels. Though a moderate body of literature appears to demonstrate improved outcomes with the introduction of ACS systems, much of this literature is retrospective in nature, and subject to significant bias. There are still many questions that remain unanswered, and it is our belief that the ACS surgeons at London Health Sciences Center are uniquely positioned to help answer these questions.
 
To facilitate academic work on EGS and the ACS model, general surgeons at LHSC who rotate through the Acute Care and Emergency Surgery Service (ACESS), in conjunction with research staff and residents, formed the Western Ontario Research Collaborative on Acute Care Surgery (WORC-ACS).  The aim of this collaborative to is to:
 
  1. Identify research priorities in ACS
  2. Conduct high-quality single-centre retrospective and prospective studies to address these priorities
  3. To be leaders both nationally and internationally in the conduct of high-quality multicenter studies to address these priorities
  4. To be leaders in the creation of a Canadian National Acute Care Surgery Database

 
To facilitate these goals, members of the WORC-ACS will:

  1. Commit to practice EGS in an evidence-based manner
  2. Contribute to consensus proceedings to identify and prioritize topics for ACS research
  3. Maintain active involvement with the WORC-ACS group with respect to project design and implementation, data interpretation, and manuscript review in a timely fashion.

Publications

  • Murphy PB, Vogt KN, Mele TS, Hameed SM, Ball CG, Parry NG and WORC-ACS. Timely Surgical Care for Acute Biliary Disease: An Indication of Quality. Annals of Surgery. 2016 (epub ahead of print)
  • Murphy PB, Paskar D, Parry NG, Racz J, Vogt KN, Symonette C, Leslie K, Mele TS. Implementation of an Acute Care Surgery Service Facilitates Modern Clinical Practice Guidelines for Gallstone Pancreatitis. J Am Coll Surg. 2015 Nov;221(5):975-81
    http://www.ncbi.nlm.nih.gov/pubmed/26372635

  • Anantha RV, Brackstone M, Parry N, Leslie K. An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective case-control study. World J Emerg Surg. 2014 Mar 21;9(1):19
    http://www.ncbi.nlm.nih.gov/pubmed/24656174

  • Anantha RV, Parry N, Vogt K, Jain V, Crawford S, Leslie K. Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective. Can J Surg. 2014 Apr;57(2):E9-14.
    http://www.ncbi.nlm.nih.gov/pubmed/24669771

Contacts

Dr. Kelly Vogt: kelly.vogt@lhsc.on.ca
Laura Allen: laurajallen@lhsc.on.ca