The Establishment and Evolution of Acute Care Surgery
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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.
KeywordsAcute Care Surgery Trauma Critical care Emergency General surgery
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