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Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?

BACKGROUND: Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solel...

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Autores principales: al-Ayoubi, Fawzi, Eriksson, Helen, Myrelid, Pär, Wallon, Conny, Andersson, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568729/
https://www.ncbi.nlm.nih.gov/pubmed/22985447
http://dx.doi.org/10.1186/1757-7241-20-66
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author al-Ayoubi, Fawzi
Eriksson, Helen
Myrelid, Pär
Wallon, Conny
Andersson, Peter
author_facet al-Ayoubi, Fawzi
Eriksson, Helen
Myrelid, Pär
Wallon, Conny
Andersson, Peter
author_sort al-Ayoubi, Fawzi
collection PubMed
description BACKGROUND: Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. METHODS: Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. RESULTS: There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3–17) and 6 (1–22). Corresponding figures for senior registrars were 7 (0–11) and 8 (1–39). CONCLUSION: There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes.
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spelling pubmed-35687292013-02-12 Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care? al-Ayoubi, Fawzi Eriksson, Helen Myrelid, Pär Wallon, Conny Andersson, Peter Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. METHODS: Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. RESULTS: There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3–17) and 6 (1–22). Corresponding figures for senior registrars were 7 (0–11) and 8 (1–39). CONCLUSION: There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes. BioMed Central 2012-09-17 /pmc/articles/PMC3568729/ /pubmed/22985447 http://dx.doi.org/10.1186/1757-7241-20-66 Text en Copyright ©2012 al-Ayoubi et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
al-Ayoubi, Fawzi
Eriksson, Helen
Myrelid, Pär
Wallon, Conny
Andersson, Peter
Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?
title Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?
title_full Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?
title_fullStr Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?
title_full_unstemmed Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?
title_short Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?
title_sort distribution of emergency operations and trauma in a swedish hospital: need for reorganisation of acute surgical care?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568729/
https://www.ncbi.nlm.nih.gov/pubmed/22985447
http://dx.doi.org/10.1186/1757-7241-20-66
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