Acute care surgery: can New Zealand afford to wait?

Until about two decades ago, the provision of emergency surgery was implicitly linked to all aspects of surgical care in all surgical specialties. While this remains true in the smaller surgical specialties, in the larger specialties the development of subspecialisation has eroded the comprehensive nature of acute care provision. In general surgery, the numerically largest of the nine surgical specialties, the greatest challenges in provision of acute care exist. Availability of appropriately trained general surgeons to deliver generic acute and trauma care has reached crisis point. An attempt is being made in the Western World to remedy these problems. Recognising that it is increasingly difficult to span the knowledge and skill mix necessary to manage all aspects of acute care in general surgery as well as a subspecialty practice, the concept of acute care surgery has been born. To look at the status of acute care surgery in Australia and New Zealand, we conducted a PubMed search on all articles matching the words emergency, acute care, and general surgery, and reviewed any papers relevant to Australasia. Of the 270 papers found, 4 papers were relevant to Australia and New Zealand. These studies outline the advantages of an acute care model in dealing with emergency surgery and delineate few disadvantages. Whether a new training paradigm, "acute care surgery" will benefit patients, the health services, and the surgeons in New Zealand and elsewhere remains to be seen. Allowing the current trend towards inadequate numbers and training of surgeons to deliver acute care to continue is unacceptable.