دانلود رایگان مقاله انگلیسی تکامل جراحی عمومی اورژانش به عنوان یک بخش تخصصی جراحی - الزویر 2017

Over the past 10 years, acute care surgery has become widely accepted as a distinct surgical specialty and practice paradigm, encompassing 3 areas of surgical practice: trauma surgery, emergency general surgery, and surgical critical care.1,2 The recognition and formalization of the specialty continue to grow (Fig. 1), as evidenced by the increasing number of acute care surgery services at institutions throughout the US.3 There are currently 20 nonACGME, American Association for the Surgery of Trauma (AAST)-approved acute care surgery training fellowship programs, up from 7 just 5 years ago.4 Acute care surgeons provide time-sensitive care for both trauma and nontrauma surgical emergencies. There are multiple challenges in caring for these patients, including around-the-clock readiness for the provision of comprehensive care across a spectrum of disciplines, the constrained time for preoperative optimization of the patient, and the greater potential for intraoperative and postoperative complications due to the often-emergent, high-complexity, and high-acuity nature of care. Although the morbidity and mortality of acute care surgery patients, especially in the more mature disciplines of trauma and surgical critical care, have steadily improved, ensuring optimal outcomes of all patients continues to evolve. Improving outcomes will require an ongoing commitment from a diverse range of health care services, professionals, and organizations, and an emphasis on high-quality, comprehensive contemporary research.

CONCLUSIONS

As acute care surgery grows, so too will its EGS component mature as a distinct surgical subspecialty. Acute care surgery and the field of EGS, evolved to address the national crisis in emergency surgical care,45,46 the surgical workforce shortages,46 and the increased burden on emergency departments to manage surgical patients.47,48 Adequately addressing these issues will depend on maturing EGS outcomes research initiatives. Emergency general surgery outcomes research will advance the science of acute care surgery, improve EGS patient outcomes, and facilitate multi-institutional collaboration. It will also assist in the creation of EGS standards of care, and the potential implementation of a verification review process, similar to those of the American College of Surgeons in multiple other surgical subspecialties.49 Emergency general surgery needs a rigorous evaluation of its outcomes, as well as creation of evidence-based benchmarks, the ongoing improvement of its care, informed performance improvement initiatives, and analyses of its systems of care. This will take energy, resources, and time, the widespread commitment of all acute care surgery stakeholders, and the continued progressive leadership of the AAST, EAST, and the American College of Surgeons.