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Is Trauma Surgery (General) becoming more non-operative ? And why?
Trauma Surgery becoming non-operative
- Thread starter N-transition
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Absolutely.
Better characterization of natural Hx of specific injuries
Better imaging for diagnosing and tracking evolution
Many injuries that were formerly operated on, are relatively rarely done now.
Ex being splenectomy. These are frequently followed now as many remain encapsulated and hemodynamically stable.
Sorry if I overstepped my knowledge fund, surgeons
Better characterization of natural Hx of specific injuries
Better imaging for diagnosing and tracking evolution
Many injuries that were formerly operated on, are relatively rarely done now.
Ex being splenectomy. These are frequently followed now as many remain encapsulated and hemodynamically stable.
Sorry if I overstepped my knowledge fund, surgeons
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I had this question too. Anyone else have any other thoughts?
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I'm not a surgeon, much less a trauma surgeon, but I'll shed a little light on this one. As was already stated, some conditions that were once automatically taken to the OR are managed (at least initially) conservatively. These days, that also includes low grade liver lacerations as well as spleens.
But that's not the big reason there's less operating to be done in trauma surgery now. The big reason is that nationwide, the rate of penetrating trauma has been falling for well over a decade. Meanwhile the rate of blunt trauma (largely auto accidents) has been increasing. The majority of operative problems for auto accidents tend to be orthopedic, so no fun for the trauma surgeon there.
But that's not the big reason there's less operating to be done in trauma surgery now. The big reason is that nationwide, the rate of penetrating trauma has been falling for well over a decade. Meanwhile the rate of blunt trauma (largely auto accidents) has been increasing. The majority of operative problems for auto accidents tend to be orthopedic, so no fun for the trauma surgeon there.
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On top of all what was stated above, trauma operations are no longer multi-stage bloodbaths but mainly speedy damage control procedures. most surgeons aim to be out of the or in an hour or less, so that they can spend time in the icu adequately resuscitating a whacked out system. additionally, the interventional radiologists are becoming an integral part of the trauma team, and on many cases (pelvic fractures, esp), more time is spent in the IR than the OR. still it's an exciting specialty and you are still taking care of the sickest patients in the hospital, so it's no less of a challenge, plus this method is increasing survival rates.
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i would say that 'trauma surgery' is still largely an operative practice. sure, there is a abundant lit on non-op managment of liver and spleen injuries. we're getting better at selecting pts to operate on...but i think you'll find if you rotate in a heavy level one trauma center, that you're operating your ass off.
