Emergency general surgery and the implications for specialisation

• Published in: The surgeon (Edinburgh) 2004-06, Vol.2 (3), p.165-170
• Main Authors: Dawson, E.J., Paterson-Brown, S.
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - mortality; Abdominal Pain - surgery; Biological and medical sciences; Craniocerebral Trauma - diagnosis; Craniocerebral Trauma - mortality; Craniocerebral Trauma - surgery; Elective Surgical Procedures - utilization; Emergency general surgery; Emergency Service, Hospital - utilization; Emergency Treatment - utilization; Female; General aspects; Health Care Surveys; Hospitals, General; Humans; Incidence; Ireland - epidemiology; Male; Medical sciences; Patient Admission - statistics & numerical data; Quality of Health Care; Retrospective Studies; Risk Assessment; specialisation; Specialties, Surgical - statistics & numerical data; Surgery Department, Hospital - utilization; Survival Rate; Workload
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/S1479-666X(04)80079-9

Background and Purpose: To examine the overall spectrum of emergency general surgical admissions and operations in Edinburgh, to identify the influence of an Accident and Emergency (A&E) department and observe the current practice of sub-specialisation. Patients and Methods: Data for all general surgical admissions and operations in the two main Edinburgh hospitals are recorded prospectively using the Lothian Surgical Audit system. These data were examined for 1999. Results: 5346 patients were admitted to the two hospitals with acute surgical conditions. Head injuries (n = 1069, 20%) and Non Specific Abdominal pain (NSAP) (n = 855, 16%) made up a third of all emergency surgical admissions. The most common single category of operations were those done on the appendix (n = 348, 15%). The Royal Infirmary, with the only A&E department had more acute surgical admissions (n = 4071) than the Western General Hospital (n = 1275), surgeons in the Royal Infirmary also operated on a much lower percentage of patients (30% v 55%). In the Royal Infirmary, upper gastrointestinal surgeons treated a significantly higher proportion of patients with upper gastro-intestinal and hepatobiliary/pancreatic conditions than either the general or colorectal surgeons and, similarly, the colorectal surgeons treated a higher proportion of patients with colorectal conditions than either the general or upper gastro-intestinal surgeons. Conclusion: The spectrum of emergency admissions and operations in Edinburgh is consistent with previously published data. An A&E department alters the spectrum of diagnoses and, therefore, the overall workload. Specialisation in emergency surgery is already quite advanced. These results all have important implications in future healthcare planning