Plastic surgical operative workload in major trauma patients following establishment of the Major Trauma Network in England: a retrospective cohort study

Summary Introduction The introduction of Major Trauma Centres (MTCs) in England has led to 63% reduction in trauma mortality . The role of plastic surgeons supporting these centres has not been quantified previously. This study aimed to quantify plastic surgical workload at an urban MTC to determine...

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Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2016-07, Vol.69 (7), p.881-887
Main Authors: Hendrickson, S.A., Ms, Khan, M.A., MBBS(Lond), MRCS(Eng), FRCS(GenSurg), AKC, Verjee, L.S., PhD, FRCS(Plast), Rahman, K.M.A., MBChB, MSc, FRCSEd(Plast), Simmons, J., BSc, MBBS, MRCS(Eng), MSc, FRCS(Plast), Hettiaratchy, S.P., MA, DM, FRCS(Plast)
Format: Article
Language:English
Subjects:
Adult
BOAST 4
Cohort Studies
England - epidemiology
Female
Humans
Major trauma
Male
Multiple Trauma - classification
Multiple Trauma - epidemiology
Multiple Trauma - surgery
Plastic Surgery
Reconstructive Surgical Procedures - methods
Reconstructive Surgical Procedures - statistics & numerical data
Regional trauma networks
Retrospective Studies
Service design
Surgery, Plastic - manpower
Surgery, Plastic - statistics & numerical data
Trauma Centers - manpower
Trauma Centers - statistics & numerical data
Workforce provision
Workload - statistics & numerical data
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Summary:Summary Introduction The introduction of Major Trauma Centres (MTCs) in England has led to 63% reduction in trauma mortality . The role of plastic surgeons supporting these centres has not been quantified previously. This study aimed to quantify plastic surgical workload at an urban MTC to determine the contribution of plastic surgeons to major trauma care. Methods All Trauma Audit and Research Network (TARN)-recorded major trauma patients who presented to an urban MTC in 2013 and underwent an operation were identified retrospectively. Patients who underwent plastic surgery were identified and type and date of procedure(s) were recorded. Trauma operative workload data of another tertiary surgical specialty and local historical plastics workload data from pre-MTC go-live were collected for comparison. Results Of 416 major trauma patients who required surgical intervention, 29% (n=122) underwent plastic surgery. 43% involved open lower limb fractures necessitating plastic surgical involvement according to British Orthopaedic Association Standards for Trauma (BOAST) 4 guidance. Overall plastic surgery operative workload increased sevenfold post-MTC go-live. A similar proportion of the same cohort required neurosurgery (n=115; p=0.589). Discussion This study quantifies plastic surgery involvement in major trauma and demonstrates that plastic surgical operative workload is at least on a par with other tertiary surgical specialties. It also reports one centre’s experience of a dramatic change in plastic surgery activity following designation of MTC status The quantity of plastic surgical operative workload in major trauma must be considered when planning major trauma service design and workforce provision, and plastic surgical postgraduate training.
ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2016.02.003