EP864 - Impact of a Dedicated Colorectal Acute Care Surgery (CORS ACS) Service on Outcomes in Urgent and Emergent Abdominal Colorectal Procedures

ePoster Presenter(s)

• LD

  Leonardo C. Duraes, MD, PhD

  Associate Staff Colorectal Surgery
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

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Author(s)

• 

  Stefan D. Holubar, MD, MS, FACS, FASCRS

  Professor of Surgery; Director of Research
  Cleveland Clinic
  Case Western Reserve University
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
• 

  David Liska, MD

  Associate Professor, Chair
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic, Cleveland, Ohio
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
• 

  Jeremy M. Lipman, MD (he/him/his)

  Director of Graduate Medical Education
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Gilad Alon, MD (he/him/his)

  Clinical Associate
  Cleveland Clinic
  Cleveland, OH, United States

  Disclosure information not submitted.
• 

  Michael Goldenshluger, MD

  Clinical Associate
  Cleveland Clinic
  Cleveland clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• NM

  Nicole Mitchem, NP

  Nurse Practitioner
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Scott R. Steele, MD, MBA (he/him/his)

  President, Cleveland Clinic, Main Campus Submarket and Rupert B. Turnbull M.D., Endowed Chair in Colorectal Surgery
  Cleveland Clinic
  Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: While General Acute Care Surgery (ACS) services have demonstrated improved surgical outcomes in emergent and urgent surgeries, a dedicated Colorectal Acute Care Surgery (CORS ACS) model remain underutilized and understudied. In 2020, during the COVID-19 pandemic, our colorectal surgery department implemented a dedicated CORS ACS service. Under this model, colorectal surgeons and an advanced practice provider were assigned exclusively for acute care without elective responsibilities. This study aimed to evaluate the impact of the CORS ACS service on surgical outcomes for patients undergoing emergent and urgent colorectal abdominal procedures.

Methods/Interventions: Patients who underwent urgent or emergent abdominal colorectal surgery between 2005 and 2025 were identified from a prospectively maintained colorectal outcomes database using standardized definitions from the National Surgical Quality Improvement Program (NSQIP). Elective, outpatient and anorectal procedures were excluded. Patients were divided into two cohorts: pre-implementation (2005-2019) and post-implementation (2020-2025) of the CORS ACS service. Demographics, clinical characteristics, and surgical outcomes were compared between groups.

Results/Outcomes: A total of 2,059 patients were included, 1,103 (53.6%) in the pre-CORS ACS and 956 (46.4%) in the post-CORS ACS group. There were no significant differences in age (p=0.88), BMI (p=0.96), or gender distribution (p=0.95), although the ASA scores were higher in the post-CORS group. Implementation of the CORS ACS service was associated with a significant reduction in overall postoperative complications (p=0.02); rates of anastomotic leak (p=0.43), surgical site infection (p=0.1), and postoperative mortality (p=0.79) were similar between groups. Median hospital length of stay decreased significantly post-implementation of the CORS ACS service (11.1 vs. 9.4 days, p=0.004).

Conclusion/Discussion: The implementation of a dedicated Colorectal Acute Care Surgery service was associated with fewer postoperative complications and shorter hospital stays, even in a higher-risk patient population. These findings highlight the value of subspecialty-led acute care models and support the broader adoption of colorectal-specific ACS services in high-volume centers to enhance the quality and efficiency of emergency colorectal surgical care.

Demographics and short-term (30-day) outcomes before and after adoption of a colorectal acute care service, 2005 - 2025 (N=2059).
Figure represent mean (standard deviation) or frequency (proportion).