Rural general surgery in Western Australia: a diverse state of play.

Abstract

Rural general surgeons require a diverse skillset to manage the varied work required in regional settings. Access to appropriate surgical services is important but challenging due to a lack of resident rural surgeons and increasing surgical subspecialisation. This is a retrospective multi-centre study on procedures undertaken within the General Surgery departments of two regional centres in Western Australia; Albany Health Campus (AHC) and Bunbury Regional Hospital (BRH). Data was extracted from theatre management system reports from 2019 to 2023. A total of 18 140 and 21 971 procedures were performed at AHC and BRH, respectively. Endoscopic work formed 56.5% of procedural work. Both sites demonstrated significant numbers of general surgical subspecialty procedures, particularly in colorectal and upper gastrointestinal/hepatobiliary surgery. However, the scope of non-general surgical procedures undertaken by the general surgery teams showed a considerable difference, with 35% of operative procedures at AHC and 14% at BRH falling within other surgical specialty areas, primarily plastic surgery, urology, and vascular surgery. Finally, close to 5% of procedures at each site were on paediatric patients. This study documents the varied caseload undertaken by rural general surgeons in Western Australia. It highlights that general surgeons must be exposed to a broad spectrum of procedures to work in regional settings once qualified and discusses novel programs designed to equip rural surgical candidates with the skills required to manage the caseload.