تکامل جراحی عمومی اورژانش به عنوان یک بخش تخصصی جراحی Ongoing Evolution of Emergency General Surgery as a Surgical Subspecialty

EMERGENCY GENERAL SURGERY: A FIELD IN TRANSITION Emergency general surgery is an under-recognized major public health concern. The incidence and prevalence of EGS conditions exceed those of other common, highly studied public health problems, such as new-onset diabetes mellitus and newly diagnosed cancers (Fig. 2). More than 3 million patients with EGS problems are admitted annually to US hospitals, representing more than 7% of all US hospitalizations. More than 25% of EGS patients require surgery during their index admission, and there are more than 850,000 EGS operations performed annually in the US.11 Underscoring EGS as a public health problem are the increasing recognition and acceptance of acute care surgery as an integral and valuable practice paradigm in modern health care. And yet, although acute care surgery services have been instituted at many hospitals in the US, a clear majority of emergent surgical patients are managed at institutions without such a specialized service. Surgical emergencies are therefore addressed by “on call” surgeons with varied backgrounds, including the spectrum of general surgery specialties and subspecialties. Such a divergent system of managing this unique, physiologically abnormal patient population may result in delays in care, widespread practice variation, and disparate outcomes.12-15 Emergency general surgery patients present intraoperative and perioperative challenges, which are compounded by a dearth of evidence-based guidelines and protocols. For example, the absence of collective EGS investigation prevents the ability to separate the contribution of suboptimal care from that of complex physiology, contributing to poor outcomes.14,15 Although the first wave of EGS outcomes research has demonstrated that patients requiring emergency surgery represent a distinct population with a unique physiology compared with patients requiring similar but elective operations,11,14-18 robust scientific standards of practice still need to be developed. The maturation of EGS as a surgical specialty will require in-depth, risk-adjusted analyses of outcomes and an evidence-based approach to improving care.