Spain D A, Richardson J D, Carrillo E H, Miller F B, Wilson M A, Polk H C
Department of Surgery, University of Louisville, Trauma Institute, University of Louisville Hospital, Kentucky 40292, USA.
J Trauma. 2000 Mar;48(3):433-7; discussion 437-8. doi: 10.1097/00005373-200003000-00010.
Many trauma centers have separated emergency and general surgery from trauma care. However, decreased trauma volume and more frequent nonoperative management may limit operative experience and the economic viability of the trauma service. Trauma surgeons at our Level I trauma center have long provided all emergency surgical care and elective surgery. We sought to determine the impact of this policy.
We reviewed all admissions to the trauma service from June of 1992 to July of 1998 and cross-referenced this with our trauma registry. The number of major and minor procedures performed was also determined, and we reviewed all operative procedures by the trauma service for June of 1996 to October of 1998.
Total admissions by the trauma service averaged 3,003 patients/year (range, 2,798-3,198 patients). Nontrauma patients accounted for 34% of all trauma service admissions (range, 26-40%). During this time period, there was no change in volume of operative or intensive care unit procedures, whereas minor procedures recently decreased from a peak of 141/month to 50/month. This was largely due to decreased use of diagnostic peritoneal lavage (surgeon reimbursable) and an increased use of computed tomographic scan and ultrasound (not presently reimbursed) to evaluate blunt abdominal trauma. During the past 2 years, nontrauma cases accounted for 33% of all operative procedures by the trauma service.
Maintenance of emergency and general surgical care by the trauma service has allowed us to buffer impact of variations in trauma volume and to maintain operative skills in an era of increased nonoperative management of many injuries.
许多创伤中心已将急诊手术和普通外科手术与创伤治疗分开。然而，创伤病例数量的减少以及更频繁的非手术治疗可能会限制手术经验以及创伤服务的经济可行性。我们一级创伤中心的创伤外科医生长期以来一直提供所有的急诊手术护理和择期手术。我们试图确定这一政策的影响。
我们回顾了1992年6月至1998年7月期间创伤服务部门的所有入院病例，并将其与我们的创伤登记册进行交叉对照。还确定了所实施的大手术和小手术的数量，并且我们回顾了1996年6月至1998年10月期间创伤服务部门的所有手术操作。
创伤服务部门的总入院人数平均每年为3003例患者（范围为2798 - 3198例患者）。非创伤患者占创伤服务部门所有入院病例的34%（范围为26% - 40%）。在此期间，手术或重症监护病房的手术量没有变化，而小手术最近从每月141例的峰值降至每月50例。这主要是由于诊断性腹腔灌洗（外科医生可报销）的使用减少以及计算机断层扫描和超声（目前不可报销）用于评估钝性腹部创伤的使用增加。在过去两年中，非创伤病例占创伤服务部门所有手术操作的33%。
创伤服务部门维持急诊手术和普通外科手术，使我们能够缓冲创伤病例数量变化的影响，并在许多损伤的非手术治疗增加的时代保持手术技能。
