Emergency general surgery and the implications for specialisation

Abstract

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.