Inova Fairfax Hospital opened a 12 OR Ambulatory Surgery Center (ASC) as part of its expansion into outpatient surgery; two-thirds of our operative cases are same day or outpatient. The ASC is adjacent to the inpatient OR to maximize the efficiency of attending and resident staff and centralize surgery in single geographic areas. The ASC has its own mammographic capabilities; most of our breast surgeries, including sentinel node biopsies, are performed there. We have recently moved our parathyroid and A-V fistula surgery to ASC, as well as elective laparoscopic hernias and cholecystectomies.

Residents have the opportunity to see patients pre- and postoperative in surgeons' offices as well as clinics. The ambulatory pre-op area also gives the house staff and students an opportunity to examine outpatients preoperatively. A separate outpatient facility is utilized for minor procedures and a large number of ophthalmology cases.

There are 14 major inpatient ORs - as well as four Cardiac ORs - presently in use. The Inpatient Tower ORs have been reconfigured to accommodate the latest video and laparoscopic equipment including the ability to transmit the images of a surgical procedure to multiple locations within the institution. A trauma room is always available for emergencies, and on Saturday mornings, an elective schedule is available to accommodate patients and surgeons needs. The 156-bed Inova Heart Institute, adjacent to the institution, was completed in 2004. This represents a state-of-the-art facility for our internationally renowned cardiac surgical service and added another 5 operating rooms to the existing 39 rooms. Presently the cardiac service is performing over 2,000 cases.

Inova Fairfax Hospital for Children and Inova Fairfax Hospital's Women's Center has five ORs in which most of the gynecology and obstetrics procedures are performed. Pediatric cases are performed in the main OR and include pediatric neurosurgery and orthopedics, as well as general pediatric surgery.

Full-time surgical intensivist staff a 12 bed adult surgical trauma unit. A separate Cardiac Surgical Unit, a Medical Surgical Unit, Neurosciences unit, and a 14-bed PICU also house surgical patients. A 16-bed Intermediate Care Unit is used to accommodate ventilator patients who are hemodynamically stable, while a Neuro-Observation Unit is staffed to handle patients with abnormal mental status following surgery or trauma.

There are two inpatient services on general surgery. 8 full-time critical care trauma surgeons and 4 private trauma/general surgeons staff the Trauma General Surgery team. The caseload for these services is variable with an average census of 20 patients. With over 2,000 trauma admissions a year, residents on the service see the whole gamut of blunt and penetrating trauma. Four helicopters service the Inova Regional Trauma Center, including Inova's own AirCare. Patients from Northern Virginia, West Virginia and the District of Columbia brought by air and ground to our faculty. A new emergency room, capable of handling over 100,000 cases a year, will be ready in 2005.

The vascular thoracic team consists of six full-time vascular surgeons, 2 thoracic surgeons. Our vascular surgeons are endovascular-trained, and an Endovascular Operating Room is planned for the future. Last year, our thoracic service performed 400 cases including 29 esophagogastrectomies and over 200 thoracotomies and VATS. The vascular surgeons performed over 120 carotid endarterectomies and 32 abdominal aortic aneurysm resections (including endovascular).

The colorectal general team includes seven full-time colorectal surgeons who performed 31 ileoanal pouches and more than 300 colon resections as well as multiple colonoscopies. The team is comprised of our hepatobiliary surgeons who performed 32 hepatic resections for tumor. This team also has Bariatric surgeons who performed over 100 laparoscopic duodenal switches and 100 laparoscopic gastric procedures.

The fourth team is composed of general surgeons as well as several surgeons who take trauma call. This service has performed over 100 laparoscopic ventral hernias, laparoscopic bowel resections. Surgeons on this service also performed a significant number of the thyroid and parathyroid resections. The service averages 20-25 inpatients.

We have hired six physician extenders to help cover the floors and OR cases. Two physicians, three nurse practitioners and one surgical physician's assistant complement the house staff and give stability to the teams. Furthermore, in-house coverage is supplemented by the part-time house staff that assist in the OR and on the floors at night and on weekends.