Role of rural general surgeons in managing vascular surgical emergencies

A rural general surgeon has historically been required to perform a wide variety of subspecialist procedures. Increasingly sub-specialized training programs have restricted younger surgeons' experience in the general surgery-associated subspecialties. Time critical vascular surgical emergencies are frequently encountered by rural general surgeons. This study aims to audit the prevalence of vascular surgical emergencies at a geographically remote regional centre and define the role of the general surgeon in managing these patients.

A single-centre, retrospective study was performed to analyse the outcomes of the patients who presented to Dubbo Base Hospital with an emergency vascular pathology or developed such a condition during admission, between October 2010 and June 2019. Patients were identified by relevant International classification of diseases (ICD) (10th revision) diagnostic codes for vascular emergencies. Acute complications following surgery for haemodialysis access were excluded.

A total of 134 patients were identified during the study period and the majority were transferred to a tertiary centre for surgical intervention. Sixteen patients underwent emergency vascular surgery locally due to concerns about potential loss of life or limb if intervention was delayed by transfer; 69% of patients who underwent surgery locally survived with limb salvation.

While most patients can safely be transferred to a tertiary centre, some require surgery locally in order to maximize chance of life or limb preservation. There is a strong argument for exposure of general surgical trainees with an interest in rural surgery to vascular surgery and other subspecialties.