NEWS | January 20, 2015

Trauma surgery moves outside of the OR, fills gaps across specialties

(SACRAMENTO, Calif.)

Historically known as heroes who put people back together after accidents, trauma surgeons today perform a broad array of surgical procedures, are involved in planning patient care and treat patients at hospital bedsides in addition to operating rooms, a UC Davis Health System study has found.

Joseph Galente Joseph Galente

“Trauma surgery has morphed into acute-care surgery — a unique combination of trauma, emergency and critical care services,” said Joseph Galante, chief of trauma surgery at UC Davis and co-author of the study, published in the Journal of Trauma and Acute Care Surgery.

“We still do traditional trauma surgeries, but demands on our skills have grown,” said David Wisner, professor of trauma surgery and the study’s senior author. “Surgical emergencies that used to be handled by specialists in gastrointestinal, plastic, thoracic or general surgery are now just as likely to be performed by trauma surgeons.”

To get a current picture of practice patterns in their field, Wisner and Galante used University HealthSystem Consortium and Association of American Medical Colleges data, which include clinical information on 60,000 physicians at 90 academic medical centers in the U.S., to compare types and numbers of procedures performed by surgeons.

Their results showed that trauma surgeons perform a variety of urgent procedures — including gallbladder removal, appendix removal, hernia repair, and spleen repair and removal — but each makes up a small percentage of the overall work, indicating the need to be well-versed in many different types of procedures.

In addition to operating-room surgeries, trauma surgeons often perform bedside procedures such as placing catheters in veins or drainage tubes in chests. The overall number of bedside procedures, however, declined during the five-year timeframe of the study. At the same time, laparoscopic procedures increased, especially for gall bladder removal, indicating the importance of training in less-invasive technologies.

David Wisner
David Wisner

Trauma surgeons also spend appreciably more time evaluating and managing cases in addition to performing procedures, compared to other surgical specialties.

Wisner said the findings should change medical education to help prepare trauma surgery trainees for the services they will be expected to provide.

“Our work has evolved, but in a way that makes sense,” he said. “Surgery on an inflamed gall bladder is different than surgery needed as a result of chronic disease, and trauma specialists are the logical choice for surgical emergencies. Medical education needs to reflect this new reality.”

In addition to Galante and Wisner, the research team included lead author Brent Pottenger, a student at the Johns Hopkins University School of Medicine. Their study, titled “The Modern Trauma and Emergency Surgeon: Characterization of an Evolving Surgical Niche,” received no external funding.

For information about UC Davis Health System, visit http://healthsystem.ucdavis.edu.