Should trauma surgeons do general surgery?

Objective: Many trauma centers have separated emergency and general surgery from trauma care. However, decreased trauma volume and more frequent nonop erative management may limit operative experience and the economic viabilit y of the trauma service. Trauma surgeons at our Level I trauma center have long provided all emergency surgical care and elective surgery. We sought t o determine the impact of this policy. Methods: We reviewed all admissions to the trauma service from June of 1992 to July of 1998 and cross-referenced this with our trauma registry, The nu mber of major and minor procedures performed was also determined, and we re viewed all operative procedures by the trauma service for June of 1996 to O ctober of 1998, Results: Total admissions by the trauma service averaged 3,003 patients/yea r (range, 2,798-3,198 patients). Nontrauma patients accounted for 34% of al l trauma service admissions (range, 26-40%). During this time period, there was no change in volume of operative or intensive care unit procedures, wh ereas minor procedures recently decreased from a peak of 141/month to 50/mo nth. This was largely due to decreased use of diagnostic peritoneal lavage (surgeon reimbursable) and an increased use of computed tomographic scan an d ultrasound (not presently reimbursed) to evaluate blunt abdominal trauma. During the past 2 years, nontrauma cases accounted for 33% of all operativ e procedures by the trauma service. Conclusions: Maintenance of emergency and general surgical care by the trau ma service has allowed us to buffer impact of variations in trauma volume a nd to maintain operative skills in an era of increased nonoperative managem ent of many injuries.