MTP2.04 Effect of Surgeon's Seniority and Sub-speciality of Interest on Mortality after Emergency Laparotomy: A Systematic Review and Meta-analysis

Aims To evaluate effect of surgeon’s seniority (trainee surgeon versus consultant surgeon) and surgeon’s sub-speciality of interest on postoperative mortality in patients undergoing emergency laparotomy (EL) Methods A systematic review was conducted and reported according to the Cochrane Handbook for Systematic Reviews and the PRISMA statement standards, respectively. We evaluated all studies comparing the risk of postoperative mortality in patients undergoing EL between a) Trainee surgeon and consultant surgeon, and b) Surgeon without and with sub-speciality of interest related to pathology. Random effects modelling was applied for the analyses. The certainty of evidence was assessed using GRADE system. Results Analysis of 256,844 patients from 13 studies showed no difference in the risk of postoperative mortality between trainee-led and consultant-led EL (OR: 0.76, p=0.12). However, EL performed by a surgeon without sub-speciality of interest related to the pathology was associated with a higher risk of postoperative mortality compared with a surgeon with sub-speciality of interest (OR: 1.38, p<0.00001). In lower GI pathologies, EL done by upper GI surgeons resulted in higher risk of mortality compared with lower GI surgeons (OR: 1.43, p<0.00001). In upper GI pathologies, EL done by lower GI surgeons resulted in higher risk of mortality compared with upper GI surgeons (OR: 1.29, P=0.05). Conclusions While confounding by indication cannot be excluded, level 2 evidence with moderate certainty suggests that trainee-led EL may not increase the risk of postoperative mortality but EL by a surgeon with sub-speciality of interest related to the pathology may reduce the risk of mortality.