TEMA: AKUTTKIRURGI
EMERGENCY SURGERY IN EUROPE JONATHAN TILSED CONSULTANT COLORECTAL SURGEON HONORARY SENIOR LECTURER HULL YORK MEDICAL SCHOOL CHAIRMAN UEMS DIVISION OF EMERGENCY SURGERY VICE PRESIDENT EUROPEAN SOCIETY FOR TRAUMA AND EMERGENCY SURGERY KORRESPONDANSE: JONATHAN TILSED – TILSED@DOCTORS.ORG.UK
Over recent decades the international surgical commuJONATHAN TILSED
nity has pursued a surgical paradox that has encouraged
CONSULTANT COLORECTAL
specialisation in all fields of care, in the belief that this
SURGEON
gets better results, but has been reluctant to extend that
HONORARY SENIOR
paradigm to emergency surgery. Perhaps unsurprisingly,
L ECTURER HULL YORK
the care of these patients is inconsistent. The 2016 Nuff-
M EDICAL SCHOOL CHAIRMAN UEMS DIVISION OF EMERGENCY SURGERY VICE PRESIDENT EUROPEAN SOCIETY FOR TRAUMA AND EMERGENCY SURGERY
ield report documented wide variations in outcomes for emergency general surgical cases in the UK (3). For example, mortality for emergency laparotomy ranged from 3.6% to 41.7%. Emergency surgery is not simply elective surgery performed ‘out of hours’. Emergency surgical operations
I recently met a man with a heavily ‘battle-scarred’ ab-
are high risk procedures with a disproportionately high
domen. It bore a midline incision which extended from
rate of complications in comparison to elective surgery.
xiphoid to pubis and had clearly healed by secondary in-
In the USA, for example, they account for only 14% of
tention in its lower third. In addition, there were about
operations, but 54% of the morbidity and mortality (4).
a dozen smaller healed wounds scattered across the rest
These diseases are often time-dependent, requiring ei-
of his anterior abdominal wall. The result of a frenzied
ther an immediate life-saving operation with simulta-
knife attack or perhaps shrapnel from an improvised ex-
neous resuscitation or surgery as soon as possible after
plosive device? No. This was the consequence of a misdi-
resuscitation for good outcomes (5, 6). Training surgeons
agnosed appendicitis: one of the seven common condi-
to recognise and manage the physiological challenges of
tions that account for 85% of emergency general surgical
acute surgical pathology is formally addressed in only a
procedures (1) and which in 2020 alone was the subject
handful of European countries where surgical training
of 1,097 publications (2). Despite this familiarity, acute
includes time working on an intensive care unit.
appendicitis is not always an easy diagnosis. 206 I KIRURGEN 3-2021
