Nonoperative management of liver and/or splenic injuries: Effect on resident surgical experience

Michael L. Hawkins, James J. Wynn, Dale C. Schmacht, Regina S. Medeiros, Thomas R. Gadacz

Research output: Contribution to journalArticle

Abstract

Changes in the management of trauma over the past few years are significantly affecting postgraduate surgical education, with the lack of operative trauma experience being a major concern in spree programs. This problem is accentuated in residency programs that obtain their trauma caseload primarily from blunt injury. Our experience over the past 6 years confirms that the growing trend toward nonoperative management of blunt liver and spleen injuries in adults is likely to exacerbate this problem. Blunt trauma admissions to our Level I trauma center increased from 2888 from 1991 through 1993 (group A) to 3587 from 1994 through 1996 (group B). Liver and/or splenic injuries occurred with equal frequency in both groups. Whereas diagnostic peritoneal lavage was used in 26 per cent of group A, its use dropped to 2 per cent in group B as abdominal computerized tomography was used more frequently to evaluate these patients. Nonoperative management increased from 10 per cent of group A to 54 per cent of group B. As a result, therapeutic laparotomies dropped from 85 in group A (58% of patients with liver/splenic injuries) to 74 (35%) in group B and nontherapeutic laparotomies from 48 (33%) to 23 (11%). While the evolution in the management of blunt liver and splenic injuries has resulted in the avoidance of nontherapeutic laparotomies, the operative caseload available to surgical housestaff has been adversely affected. Although the Residency Review Committee has stressed the importance of the critical care management of these patients, the criteria used to evaluate the number of trauma cases in postgraduate surgical education may need to be revised.

Original languageEnglish (US)
Pages (from-to)552-557
Number of pages6
JournalAmerican Surgeon
Volume64
Issue number6
StatePublished - 1998
Externally publishedYes

Fingerprint

Liver
Wounds and Injuries
Laparotomy
Internship and Residency
Peritoneal Lavage
Education
Nonpenetrating Wounds
Trauma Centers
Advisory Committees
Critical Care
Spleen
Tomography
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Hawkins, M. L., Wynn, J. J., Schmacht, D. C., Medeiros, R. S., & Gadacz, T. R. (1998). Nonoperative management of liver and/or splenic injuries: Effect on resident surgical experience. American Surgeon, 64(6), 552-557.

Nonoperative management of liver and/or splenic injuries : Effect on resident surgical experience. / Hawkins, Michael L.; Wynn, James J.; Schmacht, Dale C.; Medeiros, Regina S.; Gadacz, Thomas R.

In: American Surgeon, Vol. 64, No. 6, 1998, p. 552-557.

Research output: Contribution to journalArticle

Hawkins, ML, Wynn, JJ, Schmacht, DC, Medeiros, RS & Gadacz, TR 1998, 'Nonoperative management of liver and/or splenic injuries: Effect on resident surgical experience', American Surgeon, vol. 64, no. 6, pp. 552-557.
Hawkins ML, Wynn JJ, Schmacht DC, Medeiros RS, Gadacz TR. Nonoperative management of liver and/or splenic injuries: Effect on resident surgical experience. American Surgeon. 1998;64(6):552-557.
Hawkins, Michael L. ; Wynn, James J. ; Schmacht, Dale C. ; Medeiros, Regina S. ; Gadacz, Thomas R. / Nonoperative management of liver and/or splenic injuries : Effect on resident surgical experience. In: American Surgeon. 1998 ; Vol. 64, No. 6. pp. 552-557.
@article{a8c429d5336e4f80859f656e0018590d,
title = "Nonoperative management of liver and/or splenic injuries: Effect on resident surgical experience",
abstract = "Changes in the management of trauma over the past few years are significantly affecting postgraduate surgical education, with the lack of operative trauma experience being a major concern in spree programs. This problem is accentuated in residency programs that obtain their trauma caseload primarily from blunt injury. Our experience over the past 6 years confirms that the growing trend toward nonoperative management of blunt liver and spleen injuries in adults is likely to exacerbate this problem. Blunt trauma admissions to our Level I trauma center increased from 2888 from 1991 through 1993 (group A) to 3587 from 1994 through 1996 (group B). Liver and/or splenic injuries occurred with equal frequency in both groups. Whereas diagnostic peritoneal lavage was used in 26 per cent of group A, its use dropped to 2 per cent in group B as abdominal computerized tomography was used more frequently to evaluate these patients. Nonoperative management increased from 10 per cent of group A to 54 per cent of group B. As a result, therapeutic laparotomies dropped from 85 in group A (58{\%} of patients with liver/splenic injuries) to 74 (35{\%}) in group B and nontherapeutic laparotomies from 48 (33{\%}) to 23 (11{\%}). While the evolution in the management of blunt liver and splenic injuries has resulted in the avoidance of nontherapeutic laparotomies, the operative caseload available to surgical housestaff has been adversely affected. Although the Residency Review Committee has stressed the importance of the critical care management of these patients, the criteria used to evaluate the number of trauma cases in postgraduate surgical education may need to be revised.",
author = "Hawkins, {Michael L.} and Wynn, {James J.} and Schmacht, {Dale C.} and Medeiros, {Regina S.} and Gadacz, {Thomas R.}",
year = "1998",
language = "English (US)",
volume = "64",
pages = "552--557",
journal = "American Surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "6",

}

TY - JOUR

T1 - Nonoperative management of liver and/or splenic injuries

T2 - Effect on resident surgical experience

AU - Hawkins, Michael L.

AU - Wynn, James J.

AU - Schmacht, Dale C.

AU - Medeiros, Regina S.

AU - Gadacz, Thomas R.

PY - 1998

Y1 - 1998

N2 - Changes in the management of trauma over the past few years are significantly affecting postgraduate surgical education, with the lack of operative trauma experience being a major concern in spree programs. This problem is accentuated in residency programs that obtain their trauma caseload primarily from blunt injury. Our experience over the past 6 years confirms that the growing trend toward nonoperative management of blunt liver and spleen injuries in adults is likely to exacerbate this problem. Blunt trauma admissions to our Level I trauma center increased from 2888 from 1991 through 1993 (group A) to 3587 from 1994 through 1996 (group B). Liver and/or splenic injuries occurred with equal frequency in both groups. Whereas diagnostic peritoneal lavage was used in 26 per cent of group A, its use dropped to 2 per cent in group B as abdominal computerized tomography was used more frequently to evaluate these patients. Nonoperative management increased from 10 per cent of group A to 54 per cent of group B. As a result, therapeutic laparotomies dropped from 85 in group A (58% of patients with liver/splenic injuries) to 74 (35%) in group B and nontherapeutic laparotomies from 48 (33%) to 23 (11%). While the evolution in the management of blunt liver and splenic injuries has resulted in the avoidance of nontherapeutic laparotomies, the operative caseload available to surgical housestaff has been adversely affected. Although the Residency Review Committee has stressed the importance of the critical care management of these patients, the criteria used to evaluate the number of trauma cases in postgraduate surgical education may need to be revised.

AB - Changes in the management of trauma over the past few years are significantly affecting postgraduate surgical education, with the lack of operative trauma experience being a major concern in spree programs. This problem is accentuated in residency programs that obtain their trauma caseload primarily from blunt injury. Our experience over the past 6 years confirms that the growing trend toward nonoperative management of blunt liver and spleen injuries in adults is likely to exacerbate this problem. Blunt trauma admissions to our Level I trauma center increased from 2888 from 1991 through 1993 (group A) to 3587 from 1994 through 1996 (group B). Liver and/or splenic injuries occurred with equal frequency in both groups. Whereas diagnostic peritoneal lavage was used in 26 per cent of group A, its use dropped to 2 per cent in group B as abdominal computerized tomography was used more frequently to evaluate these patients. Nonoperative management increased from 10 per cent of group A to 54 per cent of group B. As a result, therapeutic laparotomies dropped from 85 in group A (58% of patients with liver/splenic injuries) to 74 (35%) in group B and nontherapeutic laparotomies from 48 (33%) to 23 (11%). While the evolution in the management of blunt liver and splenic injuries has resulted in the avoidance of nontherapeutic laparotomies, the operative caseload available to surgical housestaff has been adversely affected. Although the Residency Review Committee has stressed the importance of the critical care management of these patients, the criteria used to evaluate the number of trauma cases in postgraduate surgical education may need to be revised.

UR - http://www.scopus.com/inward/record.url?scp=0031811689&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031811689&partnerID=8YFLogxK

M3 - Article

C2 - 9619177

AN - SCOPUS:0031811689

VL - 64

SP - 552

EP - 557

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 6

ER -