CIRURGIA DE URGÊNCIA PERSPECTIVA EUROPEIA. Carlos Mesquita. XXXI Congresso Nacional de Cirurgia, 2011
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1 CIRURGIA DE URGÊNCIA PERSPECTIVA EUROPEIA Carlos Mesquita XXXI Congresso Nacional de Cirurgia, 2011
2 O Cirurgião Barbeiro Jacobus de Cessolis (séc. XV) Universidade de Harvard The modern operation is safe for the patient. The modern surgeon must make the patient safe for the modern operation Lord Moynihan
3 «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
4 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 Feb 4;17:4
5 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
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11 Grupo de Trabalho para a Formação Específica em Cirurgia de Emergência
12 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
13 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 lifesaving 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 Aug;32(8):
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18 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 - korhan@taviloglu.com
19 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
20 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
21 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
22 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
23 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
24 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
25 Q 7: Is there a Trauma & Emergency Surgery Association or a similar NGO in your country? Yes: 12 countries No: Albania, Norway, Estonia Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
26 Q 7: Trauma & Emergency Surgery Associations in several countries Italy: France: Czech Republic: Spain: Finland: Portugal: Germany: Slovenia: Greece: Turkey: Austria: UK: Società Italiana di Chirurgia d Urgenza e del Trauma French Association of Emergency Surgeons Czech Trauma Surgery Association The Spanish Surgical Association section of Trauma Finnish Trauma Association Lusitanian Association for Trauma and Emergency Surgery German Society of Trauma Slovenian Trauma Society Hellenic association of trauma and emergency services Turkish Association for Trauma & Emergency Surgery Austrian Society for Trauma Surgery British Trauma Society Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
27 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
28 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
29 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 Korhan Taviloglu, MD, FACS - Istanbul University, Istanbul Medical School - General Secretary of EATES - korhan@taviloglu.com
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