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Multicenter Study
. 2008 Jun;51(3):179-84.

Rural surgery in British Columbia: is there anybody out there?

Nancy Humber  1 , Temma Frecker
Affiliations
Multicenter Study

Rural surgery in British Columbia: is there anybody out there?

Nancy Humber et al. Can J Surg. 2008 Jun.

Abstract
in English, French

Objective: To document surgical procedures performed in British Columbia between 1996 and 2001 at rural hospital sites with no resident specialist surgeons and to define the scope of practice of general practitioner (GP)-surgeons at these small-volume surgical sites.

Methods: We obtained data from published information available in the medical directories for British Columbia and from the Population Utilization Rates and Referrals For Easy Comparative Tables database (versions 6.0 and 9.0) to conduct a retrospective study of all rural BC hospitals with surgical programs that had no resident specialist surgeon and relied on GP-surgeons for emergency surgical care between 1996 and 2001. We studied surgical programs at the 12 hospitals that met inclusion criteria and interviewed the physician or nurse responsible for the program. Outcomes were measured in terms of the types and volumes of surgical procedures (elective and emergency) from 1996 to 2001, including itinerant surgery.

Results: On average, 2690 surgical procedures were performed annually at the 12 hospitals included in the study. Endoscopy, hand surgery, cesarean section, herniorrhaphy, tonsillectomy and dilation and curettage (D&C) were among the top elective and emergency procedures. For each hospital, between 8 and 26 procedures of hand surgery, cesarean section, herniorrhaphy, D&C and appendectomy were performed each year. In the 12 communities studied, 19% of all surgery was emergency and 81% elective. There was significant overlap in the types of emergency and elective procedures. GP-surgeons carried out most of the emergency procedures, which nonetheless accounted for a small portion of their surgical work.

Conclusion: GP-surgeons still perform a significant number of emergency and elective surgical procedures in rural BC hospitals. This study defines useful procedures for GP-surgeons in communities without the population base to sustain a resident specialist surgeon. This information can be used to structure training programs for GP-surgeons that will adequately meet the needs of rural communities.

Objectif: Documenter les interventions chirurgicales pratiquées en Colombie-Britannique entre 1996 et 2001 dans des hôpitaux ruraux sans chirurgien spécialiste en résidence et définir le champ d'exercice des omnipraticiens (OP)-chirurgiens de ces établissements chirurgicaux à faible volume.

Méthodes: Nous avons extrait les données des répertoires médicaux publiés en Colombie-Britannique et de la base de données Population Utilization Rates and Referrals For Easy Comparative Tables (taux d'utilisation et références à utiliser pour établir facilement des tableaux comparatifs), versions 6.0 et 9.0, afin d'effectuer une étude rétrospective portant sur tous les hôpitaux ruraux de la C. B. dotées d'un programme chirurgical, n'ayant pas de chirurgien spécialiste en résidence et comptant sur des OP-chirurgiens pour dispenser des soins chirurgicaux d'urgence entre 1996 et 2001. Nous avons étudié les programmes chirurgicaux des 12 hôpitaux satisfaisant aux critères d'inclusion et interviewé le médecin ou l'infirmière responsable du programme. Nous avons mesuré les résultats en fonction des types et des volumes des interventions chirurgicales (électives et d'urgence) de 1996 à 2001, y compris les services de chirurgie itinérants.

Résultats: En moyenne, 2690 interventions chirurgicales ont été pratiquées par année dans les 12 hôpitaux inclus dans l'étude. L'endoscopie, la chirurgie de la main, la césarienne, l'herniorrhaphie, l'amygdalectomie et la dilatation et curetage (D et C) étaient au nombre des principales interventions électives et d'urgence. Dans chaque hôpital, on a pratiqué chaque année de 8 à 26 chirurgies de la main, césariennes, herniorrhaphies, D et C et appendicectomies. Dans les 12 communautés étudiées, 19 % des interventions chirurgicales étaient urgentes et 81 % étaient électives. Il y avait un chevauchement important au niveau des types d'interventions d'urgence et électives. Les OP-chirurgiens ont pratiqué la plupart des interventions d'urgence qui ont représenté néanmoins un faible pourcentage de leur travail en chirurgie.

Conclusion: Les OP-chirurgiens pratiquent toujours un nombre important d'interventions chirurgicales d'urgence et électives dans les hôpitaux ruraux de la C. B. Cette étude définit les interventions utiles pour les OP-chirurgiens dans les communautés dont le bassin de population est insuffisant pour faire vivre un chirurgien spécialiste en résidence. Ces renseignements pourront servir à structurer des programmes de formation d'OP-chirurgiens qui répondront adéquatement aux besoins des communautés rurales.

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Figures

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FIG. 1. Annual surgical volumes 1996–2001, all sites.
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FIG. 2. Top 11 procedures 1996–1997 and 2000–2001, all sites.
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FIG. 3. Top 15 procedures (emergency and elective), all sites.
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FIG. 4. Comparison of distribution of the emergency case load with and without itinerant surgery.
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FIG. 5. Top 10 emergency procedures, all sites.
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FIG. 6. Elective and emergency procedures compared.
See this image and copyright information in PMC

References

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