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The Establishment and Evolution of Acute Care Surgery

  • L. D. BrittEmail author
Chapter
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Abstract

Acute Care Surgery is the embodiment of three distinct disciplines—trauma, critical care, and emergency surgery. Several forces created the optimal environment for the establishment of the specialty Acute Care Surgery. Perhaps the main impetus for the development of this tri-disciplinary specialty was the precipitous decline in the surgical workforce that is responsible for time-sensitive management of general surgery emergencies, such as a perforated gastrointestinal ulcer, acute complicated appendicitis, acute diverticulitis, etc.

Whether managing a patient with a perforated duodenal ulcer or enterotomy secondary to a gunshot wound in the abdomen, both early diagnosis and urgent intervention make up the cornerstone of optimal management. While there are three foundational pillars of Acute Care Surgery, the specialty continues to evolve, with an increasing emphasis on surgical rescue. Dr. Peitzman and co-authors have reported on this important role for the acute care surgeon. Twenty percent of patients with the greatest risk for developing postoperative complications account for approximately 90% of failure-to-rescue. With complications of medical or surgical care being one of the most frequent hospital-based diagnoses (exceeding even cholecystitis, intestinal obstruction, and appendicitis), Acute Care Surgery undoubtedly offers the specialty expertise needed to provide the hospital surgical rescues required to optimally address these complications. Early interventions by high-performance surgical teams provide the best opportunity to reduce failure-to-rescue rates. That high-performance specialist, in many settings, will be the acute care surgeon.

There are several “essentials” that must be addressed if Acute Care Surgery is to continue to evolve, including participation in outcome research to demonstrate the substantive benefit of this new specialty.

Keywords

Acute Care Surgery Trauma Critical care Emergency General surgery 

References

  1. American College of Emergency Physicians. (2005). Availability of on-call specialists. Available via https://www.acep.org/globalassets/uploads/uploaded-files/acep/clinical-and-practice-management/resources/on-call-specialty-shortage/oncallavail2005.pdf. Accessed 15 Mar 2018.
  2. American College of Surgeons. (2018). Advanced trauma life Support®. Available via American College of Surgeons. https://www.facs.org/quality-programs/trauma/atls. Accessed 15 Mar 2018.
  3. American College of Surgeons National Surgical Quality Improvement Program. (2013). User guide for the 2012 ACS NSQIP participant user data file. https://www.facs.org/~/media/files/quality%20programs/nsqip/ug12.ashx. Accessed 15 Mar 2018.
  4. Britt, L. D. (2004). The evolution of the “emergency surgeon”: The time has come! ANZ Journal of Surgery, 74(4), 277–279.  https://doi.org/10.1111/j.1445-2197.2004.02950.xCrossRefPubMedGoogle Scholar
  5. Britt, L. D. (2012). American Association for Surgery of Trauma and the Clinical Congress of Acute Care Surgery 2011 Presidential Address. Journal of Trauma and Acute Care Surgery, 72(1), 4–10.  https://doi.org/10.1097/TA.0b013e31823fbda3CrossRefPubMedGoogle Scholar
  6. Britt, R. C., Weireter, L. J., & Britt, L. D. (2009). Initial implementation of an acute care surgery model: Implications for timeliness of care. Journal of the American Chemical Society, 209(4), 421–424.  https://doi.org/10.1016/j.jamcollsurg.2009.06.368CrossRefGoogle Scholar
  7. Dougherty, D., & Conway, P. H. (2008). The “3T’s” road map to transform US health care. The “how” of high-quality care. JAMA, 299(19), 2319–2321.  https://doi.org/10.1001/jama.299.19.2319CrossRefPubMedGoogle Scholar
  8. Earley, A. S., Pryor, J. P., Kim, P. K., Hedrick, J. H., Kurichi, J. E., Minogue, A. C., et al. (2006). An acute care surgery model improves outcomes in patients with appendicitis. Annals of Surgery, 244(4), 498–504.PubMedPubMedCentralGoogle Scholar
  9. Ekeh, A. P., Monson, B., Wozniak, C. J., Armstrong, M., & McCarthy, M. C. (2008). Management of acute appendicitis by an acute care surgery service: Is operative intervention timely? Journal of the American College of Surgeons, 207(1), 43–48.  https://doi.org/10.1016/j.jamcollsurg.2008.01.016CrossRefPubMedGoogle Scholar
  10. Ghaferi, A. A., Birkmeyer, J. D., & Dimick, J. B. (2011). Hospital volume and failure to rescue with high-risk surgery. Medical Care, 49(12), 1076–1081.  https://doi.org/10.1097/MLR.0b013e3182329b97CrossRefPubMedGoogle Scholar
  11. Halsted, W. S. (1904). The training of the surgeon. Bulletin of the Johns Hopkins Hospital, 15, 267–275.Google Scholar
  12. Institute of Medicine. (2006). IOM report: The future of emergency care in the United States Health System. Academic Emergency Medicine, 13(10), 1081–1085.  https://doi.org/10.1197/j.aem.2006.07.011CrossRefPubMedGoogle Scholar
  13. Institute of Medicine and National Research Council Committee on Trauma Research. (1985). Injury in America: A continuing public health problem. Washington, D.C.: National Academies Press.Google Scholar
  14. Ivy, M., Angood, P., Kirton, O., Shapiro, M., Tisherman, S., & Horst, M. (2000). Critical care medicine education of surgeons: Recommendations from the Surgical Section of the Society of Critical Care Medicine. Critical Care Medicine, 28(3), 879–880.CrossRefGoogle Scholar
  15. King Jr., M. L. (1958). Out of the long night. Gospel messenger. Elgin, IL: Official Organ of the Church of the Brethren. The General Brotherhood Board.Google Scholar
  16. Maa, J., Carter, J. T., Gosnell, J. E., Wachter, R., & Harris, H. W. (2007). The surgical hospitalist: A new model for emergency surgical care. Journal of the American College of Surgeons, 205(5), 704–711.CrossRefGoogle Scholar
  17. Peitzman, A. B., Sperry, J. L., Kutcher, M. E., Zuckerbraun, B. S., Forsythe, R. M., Billiar, T. R., et al. (2015). Redefining acute care surgery: Surgical rescue. Journal of Trauma and Acute Care Surgery, 79(2), 327.CrossRefGoogle Scholar
  18. Ries, A., & Ries, L. (2004). The origin of brands: How product evolution creates endless possibilities for new brands. New York: Harper Collins.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of SurgeryEastern Virginia MedicalNorfolkUSA

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