Current status of the Korean acute care surgery system for non-traumatic abdominal emergency surgery: a single-regional trauma center study

Ji Young Jang; Hongjin Shim; Jae Hun Kim; Suk-Kyung Hong; Keum Seok Bae

doi:10.5124/jkma.2019.62.2.130

J Korean Med Assoc > Volume 62(2); 2019 > Article

Jang, Shim, Kim, Hong, and Bae: Current status of the Korean acute care surgery system for non-traumatic abdominal emergency surgery: a single-regional trauma center study

Special Contribution

Journal of the Korean Medical Association 2019; 62(2): 130-134.

Published online: February 21, 2019

DOI: http://dx.doi.org/10.5124/jkma.2019.62.2.130

Current status of the Korean acute care surgery system for non-traumatic abdominal emergency surgery: a single-regional trauma center study

Ji Young Jang, MD¹

, Hongjin Shim, MD¹

, Jae Hun Kim, MD²

, Suk-Kyung Hong, MD³

, Keum Seok Bae, MD¹

¹Regional Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.

²Department of Trauma Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

³Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Keum Seok Bae. bksgs@yonsei.ac.kr

Received January 10, 2019 Accepted February 08, 2019

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Abdominal sepsis is mainly caused by intra-abdominal or retroperitoneal infection; therefore, early detection of the source of infection and adequate, prompt treatment are the most important contributors to patient outcomes. Because patients with sepsis often receive emergency abdominal surgery after regular hours, and most patients need critical care postoperatively, the need for personnel to specialize in these areas has emerged. The concept of acute care surgery (ACS), which includes trauma care, emergency general surgery, and surgical critical care, has been discussed since the early 2000s, and ACS fellowships were launched in the United States in 2008. ACS teams have been found to reduce mortality and complication rates, to decrease the time to surgery, and to lower financial costs in comparison to the traditional surgical model. In Korea, a regional trauma center project was started in 2012, and the government provided funding for each trauma center as part of this project. In the ACS field, the system for non-trauma emergency surgery is currently in the early stages of discussion. The need for such a system has been accelerated by the reduction of working hours per week of residents, as well as the shortage of manpower for emergency general surgery and surgical critical care on the night shift. In this review, we discuss the manpower problems that impact the treatment of abdominal emergency patients, and consider ways in which the Korean ACS system can treat these patients professionally.

Surgery; Emergencies; Abdomen, acute; Sepsis; Abdominal injuries

Notes

Presented at the 37^th Korean Society of Critical Care Medicine Annual Congress, Seoul, Korea, 2018.

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Figure 1

The concept of acute care surgery.

Figure 2

Emergency abdominal operations at our center. Since the establishment of the regional trauma center in 2015, there has been a slight increase in the number of abdominal trauma operations and a steep increase in the number of non-trauma abdominal operations.

Table 1

The number of emergency abdominal operations at our center by year

The number of acute appendicitis operations remained roughly constant during the study period, but the number of non-appendicitis operations significantly increased. Values are presented as number (%).

Table 2

The number of trauma operations at our center

The second operations after damage control surgery, surgery under local anesthesia, and tracheostomy were excluded. As the number of trauma surgeons at our center has increased since 2015, the number of abdominal operations performed by each surgeon decreased to approximately 20 in 2017.