Should trauma surgeons do general surgery?
OBJECTIVE
Many trauma centers have separated emergency and general surgery from trauma care. However, decreased trauma volume and more frequent nonoperative management may limit operative experience and the economic viability of the trauma service. Trauma surgeons at our Level I trauma center have long provided all emergency surgical care and elective surgery. We sought to determine the impact of this policy.


METHODS
We reviewed all admissions to the trauma service from June of 1992 to July of 1998 and cross-referenced this with our trauma registry. The number of major and minor procedures performed was also determined, and we reviewed all operative procedures by the trauma service for June of 1996 to October of 1998.


RESULTS
Total admissions by the trauma service averaged 3,003 patients/year (range, 2,798-3,198 patients). Nontrauma patients accounted for 34% of all trauma service admissions (range, 26-40%). During this time period, there was no change in volume of operative or intensive care unit procedures, whereas minor procedures recently decreased from a peak of 141/month to 50/month. This was largely due to decreased use of diagnostic peritoneal lavage (surgeon reimbursable) and an increased use of computed tomographic scan and ultrasound (not presently reimbursed) to evaluate blunt abdominal trauma. During the past 2 years, nontrauma cases accounted for 33% of all operative procedures by the trauma service.


CONCLUSIONS
Maintenance of emergency and general surgical care by the trauma service has allowed us to buffer impact of variations in trauma volume and to maintain operative skills in an era of increased nonoperative management of many injuries.
Spain
D A
DA
Department of Surgery, University of Louisville, Trauma Institute, University of Louisville Hospital, Kentucky 40292, USA. david.spain@louisville.edu
Richardson
J D
JD
Carrillo
E H
EH
Miller
F B
FB
Wilson
M A
MA
Polk
H C
HC
D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery; D003952:Diagnostic Imaging / Q000706:statistics & numerical data / Q000639:trends; D005544:Forecasting; D013502:General Surgery / Q000639:trends*; D006801:Humans; D007629:Kentucky; D010343:Patient Admission / Q000706:statistics & numerical data; D013038:Specialization / Q000639:trends*; D014193:Trauma Centers / Q000706:statistics & numerical data / Q000639:trends; D014600:Utilization Review; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*