Oesophagogastric cancer and surgical subspecialisation: how much work?
The aim of this study was to assess the volume of work generated by one consultant (out of a surgical unit of seven) managing all the upper gastrointestinal malignancy in a district general hospital serving a population of 480,000. A 3-year period was prospectively audited and the volume of out-patient and in-patient workload assessed with particular reference to resource management and levels of surgical staffing. Oesophagogastric cancer accounted for a mean of 61 new cases per year, representing 5.3% of new patient referrals. Assuming that a complex major operation for an oesophagogastric cancer equates to four intermediate equivalent values (IEVs), then this translated to a mean operative workload of 186 IEVs per year, representing 16.7% of the total elective operative workload of 1140 IEVs per year. Thus, all the oesophagogastric cancer was managed by a single firm as a speciality in a district general hospital over this 3-year period, though a relatively small proportion of new patients with oesophagogastric cancer translated into a significantly greater burden on the resources of consultant manpower and operating theatre time.
Edwards
P
P
Department of Surgery, Royal Gwent Hospital, Cardiff Road,  Newport, NP9 2UB, UK.
Barry
J D
JD
Chatterton
M C
MC
Havard
T J
TJ
Lewis
W G
WG
D004938:Esophageal Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D013502:General Surgery / Q000458:organization & administration; D006760:Hospitalization; D006767:Hospitals, District / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D008485:Medical Audit; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D011446:Prospective Studies; D013043:Specialties, Surgical / Q000458:organization & administration*; D013274:Stomach Neoplasms / Q000601:surgery*; D014852:Wales; D016526:Workload