Trauma surgery in the era of nonoperative management: The Dutch model

Background: Failing operative experience and diminished job satisfaction of trauma surgeons appears to be in part the result of nonoperative management of many blunt injuries. In the Netherlands, the responsibility of trauma surgeons includes the operative treatment of most pelvic and extremity injures, as well as the overall coordination of care. This study describes the type and number of operative procedures performed by a group of trauma surgeons at a trauma center in Amsterdam, the Netherlands. Methods: The study was conducted in a university Level I trauma center with 1,250 annual trauma admissions (90% blunt trauma), of which 125 had an Injury Severity Score of 16 or above. During a 3-year period (2001-2003), all operative interventions performed by or under direct supervision of the trauma surgeons were retrospectively analyzed and categorized into eight groups. Results: During the 3-year period, 2,011 operations were performed by the trauma surgeon group. Of these, 1,459 were single procedures and 552 were multiple interventions leading to a total of 2,784 procedures. Nonurgent procedures (n = 915) constituted 45% of the operations, whereas acute procedures (n = 1,096) accounted for 55% of the operations. Of the acute operations, almost 60% were performed during office hours; the remaining operations were performed outside office hours (evening 37%, night 13%, weekend 50%). Conclusion: This study shows that the addition of (non)operative fracture care results in a viable mix of surgical and nonsurgical management. This leads to broad skills and could enhance job satisfaction. These data could be of interest for the current discussion on the future of trauma surgery in North America and might give a lead to increase the attractiveness of our profession for future trauma surgeons.