Acute Care Surgery: A New Training and Practice Model in the United States

Less than 50 per cent of surgical critical care (SCC) fellowship positions are filled each year. We surveyed senior surgical residents to determine their opinions regarding a career in SCC and acute care surgery. A survey was sent to 1348 postgraduate year 3, 4, and 5 residents in the United States. Two hundred fifty-one surveys were returned (19% response rate). Whereas 78 per cent were planning to complete a fellowship, 21 per cent expressed interest in SCC. Fifty-six per cent plan to handle SCC problems only for their own patients, whereas 39 per cent plan to turn this management over to a critical care provider. SCC fellowships were considered to be potentially more appealing if the following changes could be made to the existing structure: adding more general surgery (70% of respondents); adding more trauma experience (50%); adding emergency neurosurgery (44%); adding more emergency orthopedics (42%); or decreasing months of critical care (36%). Increasing salary enhanced appeal for 82 per cent. SCC has limited appeal for most senior surgical residents. Theoretical expansion of surgical critical fellowships to include more general or trauma surgery (acute care surgery) increased the level of interest among senior surgical residents.

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Changing Paradigms in Acute Care Surgery: A Shift to the Hindgut

The American Surgeon ◽

10.1177/000313481408000128 ◽

2014 ◽

Vol 80 (1) ◽

pp. 76-80

Author(s):

Nitin Mishra ◽

Patricia L. Roberts ◽

Peter W. Marcello ◽

Thomas E. Read ◽

Jason F. Hall ◽

...

Keyword(s):

Acute Care ◽

Surgical Procedures ◽

Nationwide Inpatient Sample ◽

The United States ◽

Gastrointestinal Perforation ◽

Acute Care Surgery ◽

The Past ◽

Care Surgery ◽

Upper Gastrointestinal ◽

Colorectal Procedures

In this study we sought to identify changes in the etiology and surgical treatment of acute gastrointestinal perforations in the United States over the past 20 years. We performed a retrospective review of the Nationwide Inpatient Sample from January 1, 1988, through December 31, 2007. We first identified all patients with gastrointestinal perforations, the perforated organ, and treatment rendered. During the study period, 550,132 patients experienced a gastrointestinal perforation for a mean rate of 3.9 cases per 1,000 discharges. Total number of perforations rose significantly over the study period, yet surgical procedures were performed in less than half of the patients (47.6%). The most common surgical procedures for gastrointestinal perforation were colorectal in origin (38.3%), upper gastrointestinal tract (30.0%), small intestine (29.2%), esophagus (3.0%), and anus (0.1%). At study end, colorectal procedures for perforation were the most commonly performed (40.4%), whereas upper gastrointestinal procedures experienced the greatest decline. In conclusion, our data demonstrate a decline in procedures for upper gastrointestinal perforation and an increase in colorectal procedures during the two-decade study period. These data should be used to assist in the training of acute care surgeons.

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Acute care surgery practice model: Targeted growth for fiscal success

Surgery ◽

10.1016/j.surg.2013.07.012 ◽

2013 ◽

Vol 154 (4) ◽

pp. 867-874 ◽

Cited By ~ 8

Author(s):

Matthew S. Alexander ◽

Chris Nelson ◽

Jeff Coughenour ◽

Matthew A. Levsen ◽

Carol L. Toliver ◽

...

Keyword(s):

Acute Care ◽

Acute Care Surgery ◽

Practice Model ◽

Care Surgery

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Operative Hemostasis in Trauma and Acute Care Surgery: The Role of Biosurgical Agents

10.5772/intechopen.94100 ◽

2020 ◽

Author(s):

Kyle Dammann ◽

Amanda Gifford ◽

Kathryn Kelley ◽

Stanislaw P. Stawicki

Keyword(s):

Acute Care ◽

The United States ◽

Functional Restoration ◽

Acute Care Surgery ◽

Emergency General Surgery ◽

Contamination Control ◽

Suture Ligation ◽

Surgical Emergencies ◽

Care Surgery ◽

Surgical Energy

Trauma and acute care surgery (TACS) constitutes the foundation of emergency surgical services in the United States. Blunt and penetrating traumatic injuries are a leading cause of death worldwide. Non-trauma general surgical emergencies are also a major source of morbidity and mortality. Operative interventions performed within the scope of TACS often revolve around the core principles of contamination control, hemostasis, surgical repair, and subsequent functional restoration. Hemorrhage control is an integral part of emergent operative interventions, and while most instances of surgical bleeding require direct suture ligation or some other form of direct tissue intervention, some circumstances call for the use of adjunctive means of hemostasis. This is especially applicable to situations and settings where direct applications of surgical energy, suture ligation, or direct compression are not possible. Difficult-to-control bleeding can be highly lethal and operative control can be very challenging when confounded by the lethal triad of acidosis, coagulopathy and hypothermia. Topical biosurgical materials (BSM) are of great value in such scenarios, and their use across a variety of settings, from pre-hospital trauma application to emergency general surgery operations, represents an important adjunct to improve patient outcomes. Here we present the different BSMs, discuss their various uses, and provide insight on future applications and developments in this important area.

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Acute Care Surgery Billing, Coding and Documentation Series Part 3: Coding of Additional Select Procedures; Modifiers; Telemedicine Coding; Robotic Surgery

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000587 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000587

Author(s):

Thomas Esposito ◽

Robert Reed ◽

Raeanna C Adams ◽

Samir Fakhry ◽

Dolores Carey ◽

...

Keyword(s):

Complex System ◽

Robotic Surgery ◽

Acute Care ◽

Acute Care Surgery ◽

Formal Training ◽

Experienced Surgeon ◽

Care Surgery

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work “smarter, not harder” and garner the maximum compensation for their work. We hope we have been successful in achieving and that goal that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement. This third section deals with coding of additional select procedures, modifiers, telemedicine coding, and robotic surgery.

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