Emergency neurosurgical care solutions: Acute care surgery, regionalization, and the neurosurgeon: Results of the 2008 CNS consensus session

OBJECTIVE: Organized general surgery has recently proposed creation of a new acute care surgery subspecialty to include emergency care of basic neurosurgical and orthopedic surgical problems. Little is known about neurosurgical attitudes toward this proposal and alternative methods of improving access to emergency neurosurgical care. METHODS: During a consensus session at the 2008 Annual Meeting of the Congress of Neurological Surgeons (CNS), electronic data were collected regarding neurosurgeons?' attitudes toward acute care surgery, emergency neurosurgical care regionalization, and other regulatory options. RESULTS: Ninety-nine attendees participated in polling, broadly representing private (45%) and academic (34%) practices from all regions of the United States. Eighty-nine percent reported taking emergency calls (75% at least twice per week), with the majority (57%) not receiving a stipend. Only 9% responded that routine emergency cases are frequently transferred from their hospital. The majority (60%) either agreed or strongly agreed that there are problems with neurosurgery emergency coverage in their region. Before the session, 89% were opposed to the acute care surgery initiative as a solution for neurosurgery emergency coverage and 85% favored regionalization of emergency care. Opinions did not change significantly following expert presentations and discussion. CONCLUSION: Neurosurgeons polled during a 2008 CNS consensus session opposed creation of an acute care surgery specialty within general surgery that covers neurosurgical emergencies, but they favored neurosurgical emergency care regionalization. The CNS consensus sessions provide a forum for discussing socioeconomic and professional issues important to neurological surgery and for formulating preliminary information and strategies of use to regulatory stakeholders in addressing these issues.