DOI: http://dx.doi.org/10.18203/2349-2902.isj20204130

Did general surgeons surgical spectrum changed over time? A retrospective comparative study in a South Indian tertiary care centre between 2009 and 2018

Veena Gade, Someswara Rao Meegada, Chakrapani Alavala

Abstract


Background: General surgery discipline has fragmented into several subspecialties over the past. This division has affected the surgical spectrum of general surgeons. Studies comparing the changes in the general surgeon's work spectrum were done in the ’90s but not in the recent past. Our study aims to compare the surgical spectrum of general surgeons between two time periods in our institute.

Methods: We performed a retrospective study comparing the elective surgeries performed by general surgeons in the year 2009 and 2018 in an academic tertiary care centre.

Results: There was a 28.9% rise in the total number of elective surgeries (1567 vs. 2020) in our study. There was a significant rise in the mean age of surgical patients (39.7 years vs. 41.9 years) but with no change in M: F ratio (1.7: 1). There was a significant rise in Hernia surgeries and Varicose veins surgeries (p<0.001) along with a rise in anal surgeries (p=0.018). There was a significant decrease in Breast surgeries (p=0.02) and Thyroid surgeries (p<0.001). There was a dramatic rise in the laparoscopic cholecystectomy rate (23.2% vs. 52%) and a fall in the laparoscopic appendectomy rate (26.3% vs. 8%). Open inguinal hernia surgeries were the most common surgeries performed in both the years.

Conclusions: There was an increase in the surgical volume for general surgeons but the surgical spectrum has narrowed. We recommend conducting periodic surgical audits in institutions to monitor and maintain the standards of surgeries performed by general surgeons.

 


Keywords


General surgeon, Elective surgery, Spectrum, Laparoscopy

Full Text:

PDF

References


Shoemaker CP. Changes in the general surgical workload, 1991-1999. Arch Surg. 2003;138(4):417-26.

Fernández-Cruz L. General surgery as education, not specialization. Ann Surg. 2004;240(6), 932-8.

Rutkow IM. Surgical operations in the United States, then (1983) and now (1994). Arch Surg. 1997;132:983-90.

Rutkow IM. Surgical operations in the United States: 1979 to 1984. Surgery. 1987;101:192-200.

Rutkow IM. General surgical operations in the United States, 1979 to 1984. Arch Surg. 1986;121: 1145-9.

Sullivan KM, Dean A, Soe MM. OpenEpi: A web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009;124:471-4.

Bhasin SK, Roy R, Agrawal S, Sharma R. An epidemiological study of major surgical procedures in an urban population of East delhi. Indian Journal of Surgery. 2011;73(2):131-5.

Gebresellassie HW, Tamerat G. Audit of surgical services in a teaching hospital in Addis Ababa, Ethiopia. BMC research notes. 2019;12(1):1-5.

Şeker G, Kulacoglu H, Öztuna D, Topgül K, Akyol C, Çakmak A, et al. Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter National study from Turkey. International Surgery. 2014;99(5):534-2.

Dabbas N, Adams K, Pearson K, Royle G. Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Rep. 2011;2(1):5.

Nenner RP, Imperato PJ, Rosenberg C, Ronberg E. Increased cholecystectomy rates among Medicare patients after the introduction of laparoscopic cholecystectomy. J Community Health. 1994;19(6): 409-15.

Lam CM, Murray FE, Cuschieri A. Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy in Scotland. Gut. 1996;38(2):282-4.

Pulvirenti E, Toro A, Gagner M, Mannino M, Di Carlo I. Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience. BMC Surg. 2013;13:17.

Coward S, Kareemi H, Clement F, Zimmer S, Dixon E, Ball CG, et al. Incidence of Appendicitis over Time: A Comparative analysis of an administrative healthcare database and a pathology-proven appendicitis registry. PLoS One. 2016;11(11): e0165161.

Alhamdani YF, Rizk HA, Algethami MR, Algarawi AM, Albadawi RH, Faqih SN, et al. Negative appendectomy rate and risk factors that influence improper diagnosis at King Abdulaziz University hospital. Mater Sociomed. 2018;30(3):215-20.

Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg. 2011; 201(4):433-7.

Joshi MK, Joshi R, Alam SE, Agarwal S, Kumar S. Negative appendectomy: an audit of resident-performed surgery. how can its incidence be minimized?. Indian J Surg. 2015;77(Suppl 3):913-7.