J Korean Med Assoc.  2019 Feb;62(2):130-134. 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

• Jang JY
• Shim H
• Kim JH
• Hong SK
• Bae KS

• KMID: 2438373
• DOI: http://doi.org/10.5124/jkma.2019.62.2.130

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.

Keyword

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

MeSH Terms

Abdomen, Acute
Abdominal Injuries
Critical Care
Emergencies*
Fellowships and Scholarships
Financial Management
Humans
Korea
Models, Anatomic
Mortality
Sepsis
Trauma Centers*
United States

Figure

• 

  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.

Reference

1. Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, Moore FA, Velmahos G, Coimbra R, Ivatury R, Peitzman A, Koike K, Leppaniemi A, Biffl W, Burlew CC, Balogh ZJ, Boffard K, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Wani I, Escalona A, Ordonez C, Fraga GP, Junior GA, Bala M, Cui Y, Marwah S, Sakakushev B, Kong V, Naidoo N, Ahmed A, Abbas A, Guercioni G, Vettoretto N, Díaz-Nieto R, Gerych I, Tranà C, Faro MP, Yuan KC, Kok KY, Mefire AC, Lee JG, Hong SK, Ghnnam W, Siribumrungwong B, Sato N, Murata K, Irahara T, Coccolini F, Segovia Lohse HA, Verni A, Shoko T. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013; 8:3.

2. Hoyt DB, Kim HD, Barrios C. Acute care surgery: a new training and practice model in the United States. World J Surg. 2008; 32:1630–1635.

3. Uranues S, Lamont E. Acute care surgery: the European model. World J Surg. 2008; 32:1605–1612.

4. Goslings JC, Ponsen KJ, Luitse JS, Jurkovich GJ. Trauma surgery in the era of nonoperative management: the Dutch model. J Trauma. 2006; 61:111–114.

5. Handolin L, Leppaniemi A, Vihtonen K, Lakovaara M, Lin-dahl J. Finnish Trauma Audit 2004: current state of trauma management in Finnish hospitals. Injury. 2006; 37:622–625.

6. Goosen J, Veller M. Trauma and emergency surgery: South African model. World J Surg. 2008; 32:1622–1625.

7. American Association for the Surgery of Trauma. Acute care surgery [Internet]. Chicago: American Association for the Surgery of Trauma;2014. cited 2019 Jan 29. Available from: http://www.aast.org/AcuteCareSurgery.aspx.

8. Chana P, Burns EM, Arora S, Darzi AW, Faiz OD. A systematic review of the impact of dedicated emergency surgical services on patient outcomes. Ann Surg. 2016; 263:20–27.

9. Khalil M, Pandit V, Rhee P, Kulvatunyou N, Orouji T, Tang A, O'Keeffe T, Gries L, Vercruysse G, Friese RS, Joseph B. Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: a nationwide analysis. J Trauma Acute Care Surg. 2015; 79:60–63.

10. Park DJ, Park CY, Cho HM, Lee KH, Han HS. Current status and future prospects of trauma centers in Korea. J Korean Med Assoc. 2017; 60:530–532.

11. Jang JY, Shim H, Kwon HY, Chung H, Jung PY, Kim S, Ryu H, Bae KS. Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center. Eur J Trauma Emerg Surg. 2017; 12. 27. [Epub]. https://doi.org/10.1007/s00068-017-0886-3.

12. Jung K, Matsumoto S, Smith A, Hwang K, Lee JC, Coimbra R. Comparison of outcomes in severely injured patients between a South Korean trauma center and matched patients treated in the United States. Surgery. 2018; 164:482–488.

13. Kim OH, Roh YI, Kim HI, Cha YS, Cha KC, Kim H, Hwang SO, Lee KH. Reduced mortality in severely injured patients using hospital-based helicopter emergency medical services in interhospital transport. J Korean Med Sci. 2017; 32:1187–1194.

14. Cherry-Bukowiec JR, Miller BS, Doherty GM, Brunsvold ME, Hemmila MR, Park PK, Raghavendran K, Sihler KC, Wahl WL, Wang SC, Napolitano LM. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training. J Trauma. 2011; 71:1422–1426.

15. Jang JY, Lee SH, Shim H, Choi JY, Yong D, Lee JG. Epidemiology and microbiology of secondary peritonitis caused by viscus perforation: a single-center retrospective study. Surg Infect (Larchmt). 2015; 16:436–442.

16. Kim JW, Park JH, Kim DJ, Choi WH, Cheong JC, Kim JY. The delta neutrophil index is a prognostic factor for postoperative mortality in patients with sepsis caused by peritonitis. PLoS One. 2017; 12:e0182325.