Famous Among Top Surgeons in the 90s
Chapter 1004: Surgical Awareness

Chapter 1004: Surgical Awareness

Senior Luo wanted to discuss with her their opinions on the expert lecture.

Xie Wanying said, "The ICU is very important, but it is not the most crucial for surgery right now."

Her opinions always have some surprisingly unexpected aspects.

In all matters, emphasis should be on evidence, and in medicine, statistical data is the best. Both domestic and international statistics show that among the patients admitted to the ICU, the proportion of those recovering from surgical operations is relatively small.

The biggest benefit of surgery is performing the operation itself. If surgery is not possible, it generally hopes for and requires the patient to be transferred to internal medicine. Therefore, combining both aspects indicates that the ICU may not be the most important for surgery.

Specifically, looking at various surgical departments, it’s said that even the neurosurgery department plans to create an ICU specifically for neurosurgery, similar to the cardiac surgery area, to be placed in the newly-built surgical building. Establishing an ICU in one’s own department indicates that the proportion of critical care patients post-surgery is not high, the demand for beds is not significant, and there might not even be a need for dedicated ICU doctors.

Given this, each department considers maximizing benefits as a priority, and this money should not be distributed to the ICU to earn. Moreover, in reality, most patients admitted to the ICU are emergency cases coming in with acute conditions, and even before surgery, it’s uncertain if they can undergo surgery or be classified as surgical patients. In fact, some patients just entered the ICU and died there without making it to surgery.

Xie Wanying provided another example: "The PICU admits critically ill children, with the leading cause being respiratory diseases. Followed by neurological diseases and post-operative cases. Among pediatric respiratory diseases that involve surgery, only a part may be related to cardiac issues. Most lung-related issues are generally treated medically. Both cardiac-related respiratory diseases and neurological diseases are major specialties in surgery, belonging to cardiothoracic and neurosurgery. Our hospital’s pediatric surgery should focus on general pediatric surgery, which has shorter ICU stays and high turnover rates of beds. If the preoperative assessment is done well and surgical risks are managed effectively, I believe the hospital’s decision should be to establish a few ICU beds in the pediatric surgical ward similar to the cardiac surgery area."

In this context, what Expert Li said on stage might lead to misconceptions if not considered carefully. Based on data, the significance of PICU for critically ill children is great, but not necessarily significant for pediatric surgery.

"Surgery-wise, the most important thing is to conduct a good preoperative assessment, prevent post-operative risks, and perform the surgery well. Trying to repair the situation after the surgery is too late," said Xie Wanying, expressing her fundamental understanding of surgery.

Furthermore, ICU wards now are like a big basket where patients from any department who are difficult to manage are sent to stay for a few days. However, in reality, various medical techniques in the ICU require support from specialists. For instance, intubation with a ventilator requires an anesthesiologist. Chest drainage requires thoracic surgeons. Initiating peritoneal dialysis or ECMO needs assistance from a surgeon. Some ICU doctors can’t perform bronchoscopy and endoscopic treatments, and need to call for doctors from the respiratory department or others.

The biggest difference between an ICU and a general ward, according to the standards set by the national health department, is actually the ratio of nurses to beds. In a general ward, it’s approximately 0.4 to 1, while in the ICU it’s about 2.5 to 3 to 1.