Trends in index case load and case variety in training institutions accredited by the Philippine Society of General Surgeons: A 10-year review (2009-2018)

Rationale/Objective@#The competency of surgical trainees is measured by, among other things, summative examinations and operative experience. There is little literature on general surgery training in the Philippines. This study examines the trends in operative case load and variety in training institutions accredited by the Philippine Society of General Surgeons (PSGS) from 2009-2018.@*Methods@#This is an observational cross-sectional study of the surgical outputs of PSGS accredited training institutions as reflected in their annual reports. The study determined the trends in general surgical case load and variety and their distribution across the different training institution types from 2009 to 2018.@*Results@#In the study period, there is a trend to an increasing number of operations across all categories/procedures except for trauma surgeries. Overall, the average number of cases credited to residents meets the requirements set by the PSGS. The distribution of cases, however, is not equal among residents of the different institutiontypes. Changes in scope and differences in interpretation of index operations contributed to significant changes in trends. @*Conclusion@#Recommendations include a review of definitions of index operations and strict compliance to changes, the utilization of an annual computerized database and the addition of patient outcome measures in the assessment of resident competencies.

The Philippine College of Surgeons evidence-based clinical practice guidelines on preoperative evaluation of ASA I and II adult patients undergoing elective non-cardiac surgery

@#It is the practice in most health care institutions in our country to have patients for elective surgery evaluated pre-operatively by Internists and Anesthesiologists. Practitioners don’t seem to agree on how this is to be carried out. Each institution has its own protocol and even individual physicians have their own preference, which they have learned either during their training or from experience. Physicians usually request for preoperative tests for patients undergoing elective surgery in order to minimize risk, and to serve as a baseline to detect subsequent changes. Several authors agree to this as the goal of pre-operative evaluation. This is being done to identify risk factors and to screen broadly for undiagnosed disease. Undiagnosed clinical conditions are correlated with the risk of complications during the perioperative period. This then allows the physician to identify patients with increased risk of morbidity and mortality, and to help them design preoperative strategies that can reduce these risks. These tests can be helpful to stratify risk and guide postoperative management; however, most of them are obtained because of protocol rather than medical necessity. Majority of surgeries performed are non-cardiac in nature. Mortality rates for these procedures can be as high as 4% depending on the patient’s risk and type of surgery. Cardiovascular complications account for half of all morbidities and mortalities in the perioperative period for patients undergoing non-cardiac surgery.