The modern acute care surgeon: Characterization of an evolving surgical niche

Brent C. Pottenger, Joseph M Galante, David H Wisner

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Trauma and emergency surgery continues to evolve as a surgical niche. The simple fact that The Journal of Trauma is now entitled The Journal of Trauma and Acute Care Surgery captures this reality. We sought to characterize the niche that trauma and emergency surgeons have occupied during the maturation of the acute care surgery model. Methods: We analyzed the University Health System Consortium-Association of American Medical Colleges Faculty Practice Solutions Center database for the years 2007 to 2012 for specific current procedural terminology (CPT) codes. This database includes coding and billing data for more than 90 academic medical centers throughout the United States. We analyzed frequency counts and work relative value units (wRVUs) generated for specific codes to characterize the average trauma and emergency surgeon's work experience over time. Results: We found that acute care surgeons generated 42.4% of wRVUs from procedural work and 57.6% from cognitive work. For cognitive work, critical care services generated the most wRVUs per year (25.2% of total), and subsequent hospital care was the most frequently performed activity (1,236.6 codes generated per year). For procedural work, laparoscopic cholecystectomies produced the most wRVUs per year (2.4% of total), and placement of a nontunneled catheter was the most frequently performed procedure (42.2 times per year). The average acute care surgeon performed the following numbers of procedures per year: 29.6 cholecystectomies and 20.0 appendectomies; 7.7 wound vacuum device changes; 5.9 implantation of mesh procedures; 4.9 splenectomies and 0.4 splenorrhaphies; 2.6 perirectal abscess drainage procedures; less than one component separation fascial hernia repair; and less than one video-assisted thoracic surgery. Conclusion: The modern acute care surgeon is a hybrid of critical care medicine physician and ever-evolving surgical interventionist. Acute care surgeons continue to do traditional trauma work while increasingly performing acute care surgeries. The work of acute care surgeons serves a growing role and fills a valuable niche in our health care system.

Original languageEnglish (US)
Pages (from-to)120-125
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number1
DOIs
StatePublished - Jan 13 2015

Fingerprint

Wounds and Injuries
Emergencies
Critical Care
Current Procedural Terminology
Databases
Video-Assisted Thoracic Surgery
Medical Faculties
Appendectomy
Herniorrhaphy
Laparoscopic Cholecystectomy
Cholecystectomy
Splenectomy
Vacuum
Surgeons
Abscess
Drainage
Catheters
Medicine
Delivery of Health Care
Physicians

Keywords

  • acute care surgery
  • emergency surgery
  • RVU productivity
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

The modern acute care surgeon : Characterization of an evolving surgical niche. / Pottenger, Brent C.; Galante, Joseph M; Wisner, David H.

In: Journal of Trauma and Acute Care Surgery, Vol. 78, No. 1, 13.01.2015, p. 120-125.

Research output: Contribution to journalArticle

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abstract = "Background: Trauma and emergency surgery continues to evolve as a surgical niche. The simple fact that The Journal of Trauma is now entitled The Journal of Trauma and Acute Care Surgery captures this reality. We sought to characterize the niche that trauma and emergency surgeons have occupied during the maturation of the acute care surgery model. Methods: We analyzed the University Health System Consortium-Association of American Medical Colleges Faculty Practice Solutions Center database for the years 2007 to 2012 for specific current procedural terminology (CPT) codes. This database includes coding and billing data for more than 90 academic medical centers throughout the United States. We analyzed frequency counts and work relative value units (wRVUs) generated for specific codes to characterize the average trauma and emergency surgeon's work experience over time. Results: We found that acute care surgeons generated 42.4{\%} of wRVUs from procedural work and 57.6{\%} from cognitive work. For cognitive work, critical care services generated the most wRVUs per year (25.2{\%} of total), and subsequent hospital care was the most frequently performed activity (1,236.6 codes generated per year). For procedural work, laparoscopic cholecystectomies produced the most wRVUs per year (2.4{\%} of total), and placement of a nontunneled catheter was the most frequently performed procedure (42.2 times per year). The average acute care surgeon performed the following numbers of procedures per year: 29.6 cholecystectomies and 20.0 appendectomies; 7.7 wound vacuum device changes; 5.9 implantation of mesh procedures; 4.9 splenectomies and 0.4 splenorrhaphies; 2.6 perirectal abscess drainage procedures; less than one component separation fascial hernia repair; and less than one video-assisted thoracic surgery. Conclusion: The modern acute care surgeon is a hybrid of critical care medicine physician and ever-evolving surgical interventionist. Acute care surgeons continue to do traditional trauma work while increasingly performing acute care surgeries. The work of acute care surgeons serves a growing role and fills a valuable niche in our health care system.",
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