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Trauma Surgery to Acute Care Surgery: Defining the Paradigm Shift

Galante, Joseph M. MD; Phan, Ho H. MD; Wisner, David H. MD

The Journal of Trauma: Injury, Infection, and Critical Care: May 2010 - Volume 68 - Issue 5 - p 1024-1031
doi: 10.1097/TA.0b013e3181d76bf6
Original Article

Background: Trauma surgery is gradually evolving into acute care surgery (ACS). We sought to better define this evolution by using work relative value units (wRVU) to characterize the current practices of trauma and ACS.

Methods: Fiscal year 2007–2008 data from the UHC-AAMC Faculty Practice Solutions Center database, which is comprised of coding or billing data from 85 institutions was used. We compared averages for trauma surgeons with general, oncology, and vascular surgeons.

Results: Trauma surgeons are distinct from other surgical specialties; only 43% of their total wRVU were procedural compared to 69% to 75% for vascular, surgical oncology, and general surgeons. The total procedures for each specialty were similar: trauma 660, general surgery 715, surgical oncology 713, vascular 835, but trauma surgeons performed more bedside procedures. Of the top 20 total wRVU generating procedures, 20% of trauma surgeon's were bedside compared to 0% of a general surgeon's. The wRVU or surgeon for cholecystectomy were comparable between trauma and general surgery (388 vs. 452); both groups perform about 75% of the cholecystectomies laparoscopically. With respect to appendectomies, wRVU or surgeon for trauma surgeons (180) exceeded general surgeons (128). Each group performed approximately 65% laparoscopically.

Conclusions: Trauma surgeons are distinctly different from their colleagues, with a greater emphasis on intensive care unit “cognitive” work. The number of procedures performed by trauma surgeons is comparable to other disciplines but with more “bedside” procedures. Trauma surgeons' high appendectomy wRVUs may be a reflection of the transition to an ACS model. The characterization of trauma surgery as nonoperative and intensive care unit-based is in part substantiated but there are indications of a paradigm shift toward more operative experience with transition to an ACS model.

From the Department of Surgery, Division of Trauma and Emergency Surgery, University of California, Davis Medical Center, Sacramento, California.

Submitted for publication September 25, 2009.

Accepted for publication February 1, 2010.

No financial support provided by outside sources, UC Davis Departmental funding only.

The information contained in this article was based in part on data from the Faculty Practice Solutions Center maintained by the University HealthSystem Consortium (UHC) and the Association of American Medical Colleges (AAMC).

Presented at the 68th Annual Meeting of the American Association for the Surgery of Trauma, October 1–3, 2009, Pittsburgh, Pennsylvania.

Address for reprints: Joseph M. Galante, MD, Department of Surgery, Division of Trauma and Emergency Surgery, University of California, Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817; email:

© 2010 Lippincott Williams & Wilkins, Inc.