title: Oesophagogastric cancer and surgical subspecialisation: how much work?
abstract: 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.
authors.affiliation: Department of Surgery, Royal Gwent Hospital, Cardiff Road,  Newport, NP9 2UB, UK.
authors.forename: P
authors.initials: P
authors.lastname: Edwards
authors.forename: J D
authors.initials: JD
authors.lastname: Barry
authors.forename: M C
authors.initials: MC
authors.lastname: Chatterton
authors.forename: T J
authors.initials: TJ
authors.lastname: Havard
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: 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