Key result
Emergent colon cancer resections performed by general surgeons were associated with more frequent postoperative complications compared to other specializations (OR 2.5; 95% CI 1.1-6.1).
Why the study?
The study evaluated the effect of surgical specialization and surgeon resection volume on short-term outcomes after emergent colon cancer resections.
Does surgical specialization affect postoperative complications and mortality rate in patients undergoing emergent colon cancer resection?
Cohort (n=1,121)
No
Does surgical specialization affect postoperative complications and mortality rate in patients undergoing emergent colon cancer resection?
Odds Ratio: 2.5 (95% CI 1.1–6.1)
Absolute Event Rate: 54.1% vs 51.1%
Emergent colon cancer resections performed by general surgeons are associated with higher complication rates compared to those performed by colorectal or acute care surgeons.
Hypothesis-generating for specialist involvement in emergent resections; leaves open causality and need for prospective trials.
BACKGROUND: The aim of this study was to evaluate the effect of surgical specialization and surgeon resection volume on short-term outcome after emergent colon cancer resections. METHODS: A retrospective analysis of all patients who underwent resections for colon cancer between 2011 and 2020 at Helsingborg Hospital, Sweden was performed. The senior surgeon participating in each procedure was classified as a colorectal surgeon or a non-colorectal surgeon. Non-colorectal surgeons were further divided into acute care surgeons or surgeons with other specialties. Surgeons were also divided into three groups based on median yearly resection volumes. Postoperative complications and 30- or 90-day mortality rate after emergent colon cancer resections were compared in patients operated on by surgeons with different specializations and yearly resection volumes. RESULTS: Of 1121 patients resected for colon cancer, 235 (21.0 per cent) had emergent procedures. The complication rate of emergent resections was similar in patients operated on by colorectal surgeons and non-colorectal surgeons (54.1 versus 51.1 per cent respectively), and the subgroup of acute care surgeons (45.8 per cent), whereas resections performed by general surgeons were significantly associated with more frequent complications (odds ratio (OR) 2.5 (95 per cent c.i. 1.1 to 6.1)). The complication rate was numerically highest in patients operated on by surgeons with the highest resection volumes, which differed significantly from that of surgeons with intermediate resection volumes (OR 4.2 (95 per cent c.i. 1.1 to 16.0)). There was no difference in the mortality rate of patients operated on by surgeons with different specializations or yearly resection volumes. CONCLUSION: This study documented similar morbidity and mortality rates after emergent colon resection performed by colorectal and acute care surgeons, but patients operated on by general surgeons had more frequent complications.
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Engdahl et al. (2023) conducted a cohort in Colon cancer (n=1,121). Surgical specialization (general surgeon) vs. Colorectal and acute care surgeons was evaluated on Postoperative complications (OR 2.5, 95% CI 1.1-6.1). Emergent colon cancer resections performed by general surgeons were associated with more frequent postoperative complications compared to other specializations (OR 2.5; 95% CI 1.1-6.1).
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