Watch and wait strategy could be better than emergency surge
The study analyzed hospital inpatient data for adult patients with common acute conditions who had emergency admissions to 175 acute National Health Service hospitals in England during 2010–2019. The acute conditions considered were appendicitis (268,144 cases), gallstone disease (240,977), diverticular disease (138,869), hernia (106,432); and intestinal obstruction (133,073). The study compared the effectiveness of two strategies: an emergency surgery strategy, and a non-emergency surgery strategy which included medical management with the possibility of later surgery.

The main outcome measure was the number of days that the patients were alive and out of hospital during the 90 days following the initial emergency admission. The study reported results overall and for pre-specified subgroups including the patients age, sex, number of comorbidities and level of frailty.

Overall, the study found that the average number of days that patients were alive and out of hospital before 90 days was similar between the two strategies for each of the five conditions. However, for patients with severe frailty, the non-emergency surgery strategy led to an average increase in the number of days alive and out of hospital compared to the emergency surgery strategy. For these patients with severe frailty, the average increase in the number of days alive and out of hospital over the 90-day period following the non-emergency surgery versus emergency surgery strategy was 21 days for appendicitis; 6 days for gallstone disease, 39 days for diverticular disease; 19 days for hernia; and 35 days for intestinal obstruction. The majority of patients with severe frailty who did not have emergency surgery, avoided having surgery at all within the 90-day follow-up period of the study.