Emergency surgery is non-elective surgery performed when the patient's life or well-being is in direct jeopardy. Largely performed by surgeons specializing in emergency medicine, this surgery can be conducted for many reasons but occurs most often in urgent or critical cases in response to trauma, cardiac events, poison episodes, brain injuries, and pediatric medicine.
Most surgery is elective and is performed after a diagnosis based upon a history and physical of the patient, with differential test results and the development of strategies for management of the condition. With emergency surgery, the team, as well as the surgeon, may have less information about the patient than would ordinarily be required and work under very time-dependent conditions to save a patient's life, help avoid critical injury or systemic deterioration of the patient, or to alleviate severe pain. Because of the unique conditions for urgent acute surgery, operations are usually performed by a surgical team specially trained for management of a critical, or life threatening event.
Acute surgical emergencies include:
- invasive types of resuscitation for acute respiratory failure, pulmonary embolism and pulmonary obstructions
- blunt and penetrating head, chest, abdomen injuries, largely from automobile accidents and gun shot wounds
- cardiac events, including heart attacks, cardiac shock and cardiac arrhythmia
- brain injuries and other neurological conditions
- perforated ulcer and appendix, and peritonitis
Emergency surgery can take place in any hospital setting. However, trauma centers or trauma sections of hospitals handle most emergency surgeries. Forty-four states have designated trauma centers, some states with better systems than others. A level 1 trauma center, the most advanced of the trauma center system, is equipped to get the patient to surgery beginning with trained first responders. The system relies on available operating rooms, readily available laboratory personnel, anesthesiologists, x-ray and blood bank access, intensive care nurses, and ward nurses—all trained to take the patient to the operating room within 60 minutes of the incident. If patients are in surgery within an hour they have a 25% chance of survival.
Emergency surgery follows a path from resuscitation and stabilization of the patient with a patient management team, to preparation of the patient for surgery,
Mortality rates are high for emergency surgeries. For instance, rupture of abdominal aneurysm results in death in about 50% of cases due to kidney failure from shock or disrupted blood supply. An untreated aneurysm is always fatal. Certain gastrointestinal disorders require emergency surgery, including bleeding in the digestive tract, obstructions, appendicitis and inflammation of the lining of the abdomen. Pediatric emergency surgery includes birth defects of the heart. One in 120 infants is born with a heart defect requiring surgery to unblock the flow of blood or to treat a malformed aortic valve. Heart attacks are very effectively treated with emergency surgery depending upon the part of the heart affected, whether there is arterial blockage and overall health. Arrhythmia can develop, as well as stroke. The first 48 hours are the most crucial with cardiac events and whether there is immediate medical and surgical attention. Many cardiac surgeries result in bypass procedures, with a higher death rate associated with bypass surgery done on an emergency basis. Women have more emergency heart bypass operations than men, probably due to lack of earlier cardiac care.
See also Elective surgery.
Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice 5th ed. St. Louis: Mosby, Inc., 2002.
Thacker, C.V., et al. "ARF After Open-heart Surgery: Influence of Gender and Race." American Journal of Kidney Diseases 41, no. 4, (April 2003).
American College of Emergency Physicians. <http://www.acep.org>.
DeNoon, D. "Trauma Centers: Life-or-Death Difference." WebMD Medical News. October 23, 2002 [cited June 17, 2003]. <http://www.webmd.com>.
Smith, I. M. "U.S. Trauma Centers." Virtual Hospital. April 2003 [cited June 17, 2003]. <http://www.vh.org/adult/patient/internalmedicine/aba30/2003/traumacenter.html> .
Nancy Mckenzie, PhD