THE SPECTRUM OF GENERAL SURGERY IN A RURAL HOSPITAL

Abstract

The spectrum of surgical practice seen in rural areas are pertinent because our literature is replete with articles concerning the need for general surgeons in these regions. With this respect, we aim to define the types of surgery performed by rural surgeons with its morbidity and mortality rates, and to compare our surgical experience with our surgical residency program in this study. Nine hundred and ninety four patients undergone surgical procedures by two surgeons in a rural community hospital were retrospectively reviewed from September 1997 through September 2000 and compared with the surgical residency program in the University of Çukurova, General Surgery Department. The morbidity and mortality rates were alse detected. Patients undergone surgery in rural hospital with populations fewer than l00.000. There were only one postoperative death. Overall morbidity was 4%. Case types were as follows: hernioraphy 347 (34.8%); coloproctology (including haemorroidectomy, fistulectomy, lateral internal sphincterotomy etc.) 394 (39.5%); hepatobiliary 65 (6.5%); pediatric surgery 69 (6.9%); gynecology 45 (4.5%) and urology 13(1.2%). During residency program, any pediatric surgery and only one gynecologic surgery were performed by the same authors. We concluded that a large volume of surgery was performed with low morbidity and mortality rates and low costs in the rural hospital. The operative experience of surgical residents was differed from rural surgeons. We recommend a selected surgical track in selected training programs to prepare graduates better for rural practice. Senior level rotations for orthopedic, gynecologic and pediatric surgery and mentorship with rural surgeons would be optimal.