From the Guidelines
General surgery should take responsibility for emergency department admitting diagnoses that involve acute abdominal conditions, such as appendicitis, cholecystitis, bowel obstruction, perforated viscus, diverticulitis, and gastrointestinal bleeding, as well as trauma requiring surgical intervention and certain soft tissue infections, including necrotizing soft tissue infections and traumatic injuries requiring surgical evaluation. These conditions often require immediate surgical assessment, possible operative intervention, and specialized surgical care, and may present with acute pain, systemic inflammatory response, or physiologic derangements that benefit from surgical expertise 1.
Some of the key emergency department admitting diagnoses that general surgery should take responsibility for include:
- Appendicitis, which is the most common general surgery emergency presentation and the most common cause of intra-abdominal sepsis worldwide 1
- Cholecystitis, which is a common cause of acute abdominal pain and may require surgical intervention 1
- Bowel obstruction, which can be caused by a variety of factors, including adhesions, hernias, and tumors, and may require surgical intervention to relieve the obstruction 1
- Perforated viscus, which is a life-threatening condition that requires immediate surgical intervention to prevent further complications 1
- Diverticulitis, which is a common cause of acute abdominal pain and may require surgical intervention if complications such as abscess or perforation occur 1
- Gastrointestinal bleeding, which can be caused by a variety of factors, including ulcers, tumors, and vascular malformations, and may require surgical intervention to control the bleeding 1
- Hernias with incarceration or strangulation, which require immediate surgical intervention to prevent further complications 1
- Mesenteric ischemia, which is a life-threatening condition that requires immediate surgical intervention to prevent further complications 1
- Necrotizing soft tissue infections, which require immediate surgical intervention to prevent further complications 1
- Traumatic injuries requiring surgical evaluation, which may include injuries to the abdomen, chest, or extremities, and require immediate surgical intervention to prevent further complications 1
Early surgical consultation is crucial for conditions like appendicitis or perforated viscus, where delayed intervention can lead to increased morbidity and mortality 1. While some conditions may be managed non-operatively initially, having surgical oversight ensures appropriate monitoring and timely intervention if conservative management fails 1.
From the Research
Emergency Department Admitting Diagnoses for General Surgery
The following are emergency department admitting diagnoses that general surgery should take responsibility for:
- Bowel obstruction 2
- Appendicitis 2, 3, 4, 5, 6
- Acute cholecystitis 3, 4, 5, 6
- Gallstone pancreatitis 3
- Diverticulitis 4
- Incarcerated or strangulated inguinal hernia 4
- Perforated peptic ulcer disease 4
- Small bowel obstruction 5, 6
- Emergency laparotomy 6
Specific Conditions and Their Management
General surgery should take responsibility for the management of these conditions, including:
- Operative and nonoperative management of acute surgical emergencies 2
- Laparoscopic repair of acute surgical diseases such as acute appendicitis, acute cholecystitis, and diverticulitis 4
- Use of a uniform anatomic severity grading system for emergency general surgery conditions to facilitate prospective data collection for quality improvement and research 5
Variability in Care and Outcomes
There is significant variability in care and outcomes for emergency general surgery conditions among hospitals, including: