Galante Joseph M, Phan Ho H, Wisner David H
Department of Surgery, Division of Trauma and Emergency Surgery, University of California, Davis Medical Center, Sacramento, California 95817, USA.
J Trauma. 2010 May;68(5):1024-31. doi: 10.1097/TA.0b013e3181d76bf6.
Trauma surgery is gradually evolving into acute care surgery (ACS). We sought to better define this evolution by using work relative value units (wRVU) to characterize the current practices of trauma and ACS.
Fiscal year 2007-2008 data from the UHC-AAMC Faculty Practice Solutions Center database, which is comprised of coding or billing data from 85 institutions was used. We compared averages for trauma surgeons with general, oncology, and vascular surgeons.
Trauma surgeons are distinct from other surgical specialties; only 43% of their total wRVU were procedural compared to 69% to 75% for vascular, surgical oncology, and general surgeons. The total procedures for each specialty were similar: trauma 660, general surgery 715, surgical oncology 713, vascular 835, but trauma surgeons performed more bedside procedures. Of the top 20 total wRVU generating procedures, 20% of trauma surgeon's were bedside compared to 0% of a general surgeon's. The wRVU or surgeon for cholecystectomy were comparable between trauma and general surgery (388 vs. 452); both groups perform about 75% of the cholecystectomies laparoscopically. With respect to appendectomies, wRVU or surgeon for trauma surgeons (180) exceeded general surgeons (128). Each group performed approximately 65% laparoscopically.
Trauma surgeons are distinctly different from their colleagues, with a greater emphasis on intensive care unit "cognitive" work. The number of procedures performed by trauma surgeons is comparable to other disciplines but with more "bedside" procedures. Trauma surgeons' high appendectomy wRVUs may be a reflection of the transition to an ACS model. The characterization of trauma surgery as nonoperative and intensive care unit-based is in part substantiated but there are indications of a paradigm shift toward more operative experience with transition to an ACS model.
创伤外科正逐渐演变为急性病治疗外科（ACS）。我们试图通过使用工作相对价值单位（wRVU）来描述创伤外科和急性病治疗外科的当前实践，从而更好地界定这一演变过程。
使用了来自UHC - AAMC教员实践解决方案中心数据库2007 - 2008财年的数据，该数据库由85家机构的编码或计费数据组成。我们将创伤外科医生与普通外科、肿瘤外科和血管外科医生的平均值进行了比较。
创伤外科医生与其他外科专科不同；他们总wRVU中只有43%是程序性的，而血管外科、外科肿瘤学和普通外科医生的这一比例为69%至75%。各专科的总手术量相似：创伤外科660例，普通外科715例，外科肿瘤学713例，血管外科835例，但创伤外科医生进行的床边手术更多。在产生总wRVU最高的20项手术中，创伤外科医生的20%是床边手术，而普通外科医生为0%。创伤外科和普通外科胆囊切除术的wRVU或医生相当（388对452）；两组腹腔镜胆囊切除术的比例均约为75%。关于阑尾切除术，创伤外科医生的wRVU或医生（180）超过普通外科医生（128）。每组腹腔镜手术的比例约为65%。
创伤外科医生与他们的同行明显不同，更侧重于重症监护病房的“认知”工作。创伤外科医生进行的手术数量与其他学科相当，但“床边”手术更多。创伤外科医生阑尾切除术的高wRVU可能反映了向急性病治疗外科模式的转变。将创伤外科描述为非手术和以重症监护病房为基础在一定程度上得到了证实，但有迹象表明，随着向急性病治疗外科模式的转变，正在向更多手术经验的范式转变。
