Emergency general surgery and the implications for specialisation

Abstract

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. 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. 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. 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.