CIRURGIA DE URGÊNCIA PERSPECTIVA EUROPEIA Carlos...

CIRURGIA DE URGÊNCIA – PERSPECTIVA EUROPEIA

Carlos Mesquita

XXXI Congresso Nacional de Cirurgia, 2011

“The modern operation is safe for the patient. The modern surgeon must make the patient safe

for the modern operation”

Lord Moynihan

“O Cirurgião Barbeiro”

Jacobus de Cessolis (séc. XV) Universidade de Harvard

«The story is always the same; we can call it emergency surgery, acute care surgery, or "Samantha," but the key point is that we do not have a widespread set of minimum standards for emergency surgery. Such standards are just as important as those of ATLS. We need to develop guidelines regarding organizational models to address diseases requiring urgent surgical intervention.(…) If we fail to meet this objective, we will continue to witness preventable complications and deaths (…). This is a dream, but it needn't be a broken one. (…) If we can successfully develop solid guidelines for surgeons from all around the world we will have accomplished a small yet important "humanitarian mission”. These guidelines would be freely available (…) and surgeons all around the world could reference them. You can call it emergency surgery or acute care surgery, but not the "Boulevard of Broken Dreams".» Catena F, Moore EE. Emergency surgery, acute care surgery and the boulevard of broken dreams. World Journal of Emergency Surgery 2009, 4:4

www.wses.org.uk

http://www.wses.org.uk/

The specialties dealing with emergency medicine and emergency surgery are in need for a new roadmap. (…) Obviously, choosing a career dealing (solely) with emergencies and trauma is associated with concerns related to lifestyle issues and, for surgeons, maintenance of adequate operative experience with the increased non-operative management. Also, dealing with patients' whose outcome may be dismal with high associated morbidity and mortality is often not viewed as rewarding. (…) How surgeons around the world will deal with this challenge will likely be diverse and tailored according to the needs of any given region, (…)in order to keep in line with the centennial words of Halstead that "every important hospital should have on its resident staff of surgeons at least one who is well and able to deal with any emergency that may arise". Søreide K. Trauma and the acute care surgery model - should it embrace or replace general surgery? Scand J Trauma Resusc Emerg

Med. 2009 Feb 4;17:4

•This journal started publishing as

UNFALLCHIRURGIE, in 1975

• In 2000, this journal was renamed to

EUROPEAN JOURNAL OF TRAUMA

•EUROPEAN JOURNAL OF TRAUMA AND

EMERGENCY SURGERY, since 2007

Grupo de Trabalho para a

Formação Específica em Cirurgia de Emergência

Grupo de Trabalho para a Formação Específica em Cirurgia de Emergência Carlos Mesquita (SRC) CCEM – Coordenador Renato Bessa de Melo (SRN) Cirurgia Geral / GT Luís Filipe Pinheiro (SRC) Cirurgia Geral / ALTEC Nelson Olim (SRS) Cirurgia Geral / SPT Fernando Ferreira (SRN) Cirurgia Geral / CT-SPC Jorge Pereira (SRC) Cirurgia Geral / CT-SPC Mário Mendes (SRS) Cirurgia Geral / CT-SPC

Tiago Coelho (SRN) Cirurgia Pediátrica Carlos Duarte Franco (SRN) Cirurgia Cardiotorácica António Figueiredo (SRC) Ortopedia Arnaldo Figueiredo (SRC) Urologia Luís Mendes Pedro (SRS) Cirurgia Vascular João Paulo Farias (SRS) Neurocirurgia

There is no European consensus on acute care surgery. In some

central European countries, specialists qualify in general and

orthopedic trauma surgery; these all rounders also perform life-

saving thoracic and neurosurgical procedures, such as emergency

thoracotomies and craniotomies. The European model is not a

uniform system for acute surgical care.

Uranues S, Lamont E. Acute care surgery: the European model. World J Surg. 2008 Aug;32(8):1605-12

Questionnaire - Future of Emergency Surgery in Europe

1 Albania Agron Dogjani

2 Austria Selman Uranues

3 Czech Republic Milos Janecek

4 Estonia Juri Teras

5 Finnland Ari Leppaniemi

6 France Abe Fingerhut

7 Germany Hans Oestern

8 Greece Spyros Stergiopulos

9 Italy Enrico Cavina & Fausto Catena

10 Norway Kari Schroder Hansen

11 Portugal Carlos Mesquita

12 Slovenia Vladimir Smrkolj

13 Spain Jose Maria Jover

14 Turkey Korhan Taviloglu

15 UK Alastair Wilson

Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - [email protected]

mailto:[email protected]

Q 1: How do you define an emergency surgeon in your country?

Standard General Surgeon:

• Albania, France, Norway, Spain, Greece, Turkey, Austria

General Surgeon with additional training:

• Italy, Czech Republic, Finland, Portugal, Germany, Slovenia, Estonia,

UK



Q 2: Which specialty is occupied in emergency services in your country?

General Surgery:

• Italy, France, Albania, Czech Republic, Germany, Greece, Norway, Spain, Finland, Slovenia, Turkey, Estonia, Austria, UK

Orthopedic Surgery:

• Italy, France, Albania, Czech Republic, Germany, Greece, Norway, Spain, Finland, Turkey, Estonia, Austria, UK

Neurosurgery:

• Estonia

Vascular Surgery:

• Estonia

Anesthesiology:

• Italy, France, Albania, Czech Republic, Germany, Greece, Turkey, Estonia, Austria, UK

Emergency Physician:

• Italy, France, Norway, Spain, Portugal, Turkey, Estonia

General Medicine:

• Italy, France, Portugal, Slovenia, Turkey, Estonia, Austria



Q 3: Are there designated emergency surgery centers in your country?

Yes:

• Italy, Albania, Norway, Czech Republic, Turkey, Estonia, UK

No:

• France, Spain, Finland, Portugal, Slovenia, Greece, Germany, Austria



Q 4: How are they staffed?

General surgeon with additional training:

• Italy, Norway, Czech Republic, Estonia

Standard General Surgeon:

• Albania, Turkey, UK

Trauma surgeon:

• Germany, Austria



Q 5: How should the structure of training/continuing education in emergency surgery management be?

General surgeon with trauma & emergency surgery specialization:

• Italy, Albania, France, Norway, Czech Republic, Spain, Finland,

Portugal, Germany, Slovenia, Greece, Turkey, Estonia, UK

General surgeon with gastrointestinal specialization:

• Austria



Q 6: What capabilities should an emergency surgeon have?

Abdominal Emergencies:

• Italy, France, Finland, Portugal, Germany, Norway, Spain, Turkey, Estonia, UK

Trauma management:

• Italy, France, Finland, Portugal, Germany, Norway, Albania, Czech Republic,

Spain, Slovenia, Turkey, Estonia, Austria, UK

Vascular emergencies:

• Italy, France, Finland, Portugal, Germany, Norway, Slovenia, Turkey, Estonia,

UK

Burn management:

• Norway, Slovenia, Turkey, Estonia

Surgical Intensive Care:

• Finland, Greece, Turkey



Q 7: Is there a Trauma & Emergency Surgery Association

or a similar NGO in your country?

Yes:

• 12 countries

No:

• Albania, Norway, Estonia



Q 7: Trauma & Emergency Surgery Associations in several countries

Italy: Società Italiana di Chirurgia d’Urgenza e del Trauma

France: French Association of Emergency Surgeons

Czech Republic: Czech Trauma Surgery Association

Spain: The Spanish Surgical Association section of Trauma

Finland: Finnish Trauma Association

Portugal: Lusitanian Association for Trauma and Emergency Surgery

Germany: German Society of Trauma

Slovenia: Slovenian Trauma Society

Greece: Hellenic association of trauma and emergency services

Turkey: Turkish Association for Trauma & Emergency Surgery

Austria: Austrian Society for Trauma Surgery

UK: British Trauma Society



Q 8: What are the major changes in emergency surgery in recent years?

• Conservative Treatment: Italy, Spain, Turkey

• Packing: Italy, Turkey

• Laparostomy: Italy

• Endoscopic surgery: Italy, Spain, Finland, Turkey

• Improvement in ICU standards: Turkey

• Improvements in int. radiology: Turkey

• Polytrauma management: Albania

• Surgical technique: Albania, Czech Republic

• Postgraduate education: France, Portugal, Turkey, Czech Republic, Portugal, Estonia

• Diploma in emergency surgery: France



IN CONCLUSION 1. An Emergency Surgeon is either a General Surgeon or a General Surgeon with additional training 2. In Emergency Services, in general, General Surgeons, Orthopedic Surgeons, Anesthesiologists,

Emergency Physicians and Practitioners are occupied 3. In some countries there are designated Emergency Surgery Centers and in some do not exist 4. In Emergency Surgery Centers, standard General Surgeons, General Surgeons with additional training

or Trauma Surgeons may be occupied 5. All countries other than Austria, believe that Emergency Surgery should be handled by General

Surgeons with trauma & emergency surgery specialization. Austria prefers a General Surgeon with gastrointestinal specialization in Emergency Surgery

6. Most of the countries believe that an Emergency Surgeon should deal with abdominal emergencies, trauma management and vascular emergencies. Some believe that burn management and S-ICU management would also be preferred

7. Other than Albania, Norway and Estonia, all countries have an NGO related to emergency surgery • These NGO’s are mostly trauma related • Italy, France, Portugal, Greece and Turkey have NGO’s related to Emergency Surgery

8. The major changes in emergency surgery in recent years are • Conservative Treatment • Packing • Endoscopic surgery • Postgraduate education • Improvement in ICU standards • Improvements in interventional radiology • Polytrauma management • Surgical technique • Laparostomy • Diploma in emergency surgery

Our wishes

• Formation of designated centers all over Europe dealing with Trauma & Emergency Surgery

• European Board of Surgery examination in Traumatology to be replaced by examination in Trauma & Emergency Surgery

• Initiate European protocols in the field of Trauma & Emergency Surgery

• Initiate multicenter European trials in the field of Trauma & Emergency Surgery

• Trauma & Emergency Surgery accepted as a formal subspecialty or fellowship lasting 2 or 3 years

• Initiate European protocols in the field of Trauma & Emergency Surgery

• Active chapters and divisions of trauma & emergency surgery including disaster medicine



CIRURGIA DE URGÊNCIA PERSPECTIVA EUROPEIA Carlos...

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