The academic trauma center is a model for the future trauma and acute care surgeon.
BACKGROUND
Strategies to prevent the extinction of the trauma surgeon have focused on increasing the operative potential by including nontrauma general surgery emergencies. Although providing comprehensive emergent surgical care by the trauma service may seem novel, our institution has embraced this concept for the past 25 years. Recent discussions on the future of trauma surgery stimulated us to review our experience as a possible model for the future trauma and acute care surgeon.


METHODS
We reviewed operative logs for 2002 and 2003 at our urban academic Level I trauma center. Six surgeons participate equally in call that covers trauma and nontrauma general surgical, thoracic, and vascular emergencies. Cases were classified as trauma, emergent, urgent, or according to the patient's clinical condition. The primary procedure for each operation was classified according to the American Board of Surgery Case Reporting System.


RESULTS
We performed 4,082 operations during the study period, of which 8% were trauma, 11% were emergent, 40% were urgent, and 41% were elective. Abdominal and alimentary procedures accounted for 53% of all operations. Vascular, thoracic, and head and neck procedures accounted for 22%, 14%, and 9% of procedures, respectively.


CONCLUSIONS
To resurrect our discipline, we must reclaim and expand our operative potential and be relieved of our excessive night and weekend burden of serving as housestaff for the neurosurgeons, orthopedic surgeons, and interventional radiologists. The trauma surgeon can effectively manage trauma and acute care surgery emergencies including thoracic and vascular conditions. Education of the future trauma and acute care surgeon must include specialty training in thoracic and vascular surgery.
Ciesla
David J
DJ
Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, Colorado, USA. david.ciesla@dhha.org
Moore
Ernest E
EE
Moore
John B
JB
Johnson
Jeffrey L
JL
Cothren
Clay C
CC
Burch
Jon M
JM
D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D003120:Colorado; D017558:Elective Surgical Procedures; D005544:Forecasting; D013502:General Surgery / Q000193:education / Q000639:trends; D006801:Humans; D017146:Models, Organizational; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D014193:Trauma Centers / Q000458:organization & administration* / Q000639:trends; D014194:Traumatology / Q000193:education / Q000639:trends