Acute Care Surgery: Fortschritt
oder nur alter Wein in neuen
Schläuchen?
PD Dr. med. Beat Schnüriger
Universitäre Klinik für Viszerale Chirurgie und Medizin
Inselspital Bern
Notfälle
Elektiv
UVCM: 35-40% Notfallpatienten
Notfälle
Elektiv
Zertifizierung (Tumor-, Darmzentrum…)
Onkologische Standards
Register
Spezialisierung
Stiftungen
Forschung
uvm…
Notfälle
Elektiv
Zertifizierung
Onkologische Standards
Register
Spezialisierung
Stiftungen
Forschung
uvm…
????
ACS Patient
• ≠ elective surgical patient (different
concepts)
• Acute surgical disease/illness
• Acutely deranged physiology
– SIRS, Sepsis, Coagulopathy, Hypothermia
• Decision making critical - Time matters
(min – hours)
Abdominal
Compartment
Syndrome
Appendicitis acuta
Ileus
Fournier gangrene
HVI perforation
Trauma
Foreign body
Incarcerated hernia
Abdominal
Compartment
Syndrome
Appendicitis acuta
Ileus
Fournier gangrene
HVI perforation
Trauma
Foreign body
Incarcerated hernia
Acute Care Surgery
Trauma Surgery
Emergency Surgery
Critical Care
Acute Care Surgery
Trauma Surgery
Emergency Surgery
Critical Care
Algorithms Decisions Knowledge
Historical Timeline
• 2003 - Meeting of ACS, AAST, WEST, EAST on future
in emergency and trauma surgery.
• 2005 - ACEP survey: 75% of EDs identify inadequate
on-call specialty coverage
• 2005 - AAST renames previous ad hoc committee -
Acute Care Surgery Committee
• 2006 - IOM report - confirms shortage of on call
specialists
• 2007 - Development of curriculum, certification criteria,
and site visits
• July 2008 - First formal AAST ACS Fellowship
• EDs and trauma centers are overcrowded
• Emergency care is highly fragmented
• Critical specialists are often unavailable to provide
emergency and trauma care
• The emergency care system is ill-prepared to handle a
major disaster
• EMS and EDs are not well equipped to handle pediatric
care
• In 2006, 122 EDs handled 1.475 million
ED visits
• Overall, 39% of visits were for trauma or
surgery
Trauma- and Emergency Surgery is:
• A significant part of surgery, with major impact on
outcome and resources
• With regard to training = the responsibility of every
surgeon, regardless of specialty
• A matter where surgeons should collaborate, not
compete
• A global problem, requiring international collaboration
• An urgent matter, and the initiative should come from
the surgeons, not from politicians
Sten Lennquist, Söderköping/SE, Oral Presentation at ECTES Amsterdam, May 10, 2015
Fast and accurate diagnosis
Critical Care
Surgical treatment («DC»)
Resuscitation
Definitive Reconstruction
Reoperation
Rehabilitation
«The ACS-Surgeons are recognized for their
availability, expertise, and improved outcomes
for urgent surgical problems»
George C. Velmahos, MD, ACS and Trauma-Director, MGH Boston