# Characteristics of emergency general surgery services in Switzerland: a nationwide survey

## TL;DR

This study surveyed emergency general surgery services in Swiss hospitals, finding challenges like limited resources in smaller hospitals and suggesting potential improvements.

## Contribution

The study provides the first nationwide survey of emergency general surgery services in Switzerland, highlighting organizational differences and resource limitations.

## Key findings

- Smaller hospitals (<100 beds) lack higher-level care units like ICU.
- Emergency operating room capacity increases with hospital size.
- Larger hospitals are more likely to have separate teams for EGS and orthopedic trauma.

## Abstract

Running an emergency general surgery (EGS) service is challenging and requires significant personnel and institutional resources. The aim of this study was to achieve a nationwide overview of the individual EGS service organizations in public hospitals in Switzerland.

All Swiss public hospitals with a surgical and emergency department were included and contacted by telephone. General surgeons were interviewed between December 2021 and January 2022 using a standardized questionnaire.

Seventy-two out of 79 public hospitals in Switzerland (91.1%) agreed to the survey. They employed 1,581 surgeons in 19 (26.4%) hospitals with < 100 beds, 39 (54.2%) hospitals with 100–300 beds, 7 (9.7%) with 300–600 beds, and 7 (9.7%) with > 600 beds. The median number of surgeons per hospital was 20.5 (IQR 13.0–29.0). Higher level of care (intermediate or intensive care unit) was significantly less available in small hospitals (< 100 beds). The median hour of designated emergency operating room capacity per day was 14 h (IQR 14–24) for all hospitals with < 600 beds and 24 h (IQR 14–24) for the largest hospitals (> 600 beds). With increasing hospital size, there was a significant increase in the number of surgical units where EGS and orthopedic trauma surgery were covered by two separate teams (21.1% vs. 43.6% vs. 85.7% vs. 100%, p = 0.035). The median number of surgeons on-call per hospital and per 24 h was 5.0 (IQR 3.3–6.0).

Lack of higher level of care in small hospitals, limited emergency OR capacity and short rotations of on-call teams are major drawbacks of many current EGS systems in Switzerland. Centralization of critically ill EGS patients and reorganization of surgical on-call systems to designated acute care surgery teams should be considered.

The online version contains supplementary material available at 10.1007/s00068-023-02272-2.