Key result
Colorectal surgeon care shows no independent 30-day mortality benefit over other general surgeons.
Why the study?
Emergency colorectal surgery has high morbidity and mortality, and the impact of consultant subspecialization on patient outcomes after emergency colorectal resections is unclear.
Does care by a colorectal surgeon reduce 30-day postoperative mortality in patients undergoing emergency colorectal resections?
Cohort (n=7,648)
Yes
Does care by a colorectal surgeon reduce 30-day postoperative mortality in patients undergoing emergency colorectal resections?
Odds Ratio: 0.75
Absolute Event Rate: 11.8% vs 15.2%
p-value: p=<0.001 (univariate), 0.380 (multivariable)
Involving colorectal subspecialists in emergency colorectal resections may improve patient outcomes, including higher rates of laparoscopy and anastomosis, though adjusted mortality differences were not significant.
No independent mortality benefit after adjustment; leaves open whether colorectal subspecialty improves emergency resection outcomes.
AIM: Emergency colorectal surgery is associated with significant morbidity and mortality. Most general surgeons have a subspecialty, which forms the focus of their elective work, allowing development of specialist skill sets. The aim of this study was to assess the impact of consultant subspecialization on patient outcomes following emergency colorectal resections. METHODS: Data were requested for all emergency admissions under a general surgeon between 1 January 2002 and 31 December 2016 within the north of England. These were acquired from individual Trusts following Caldicott approval. Data included demographics, diagnoses and any procedures undertaken. Patients were assigned to cohorts based on the subspecialist interest of the consultant they were under the care of. The primary outcome of interest was 30-day postoperative mortality. Categorical data were compared with the chi-squared test, and continuous data with the t test or ANOVA. A logistic regression model determined factors associated with 30-day in-hospital mortality. RESULTS: Overall, 7648 emergency colorectal resections were performed with a 30-day postoperative mortality of 13.8%. This was significantly lower if the responsible consultant was a colorectal surgeon compared with other general surgery subspecialties (11.8% vs. 15.2%, P < 0.001). This was significant on univariate analysis (OR 0.75, P < 0.001); however, following multivariable adjustment, this was not statistically significant (P = 0.380). The colorectal specialists had a higher laparoscopy rate than their colleagues-9.8% versus 6.8% (P < 0.001). Stoma rates were also lower (46.9% vs. 51.0%, P = 0.001) and anastomosis rates higher (55.9% vs. 49.3%, P < 0.001) amongst colorectal surgeons. CONCLUSION: These findings add to the growing body of evidence that patient outcomes may be improved by involving subspecialists in colorectal emergencies.
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Young et al. (2020) conducted a cohort in Emergency colorectal resections (n=7,648). Care by a colorectal surgeon vs. Other general surgery subspecialties was evaluated on 30-day postoperative mortality (OR 0.75, p=<0.001 (univariate), 0.380 (multivariable)). Care by a colorectal surgeon was associated with lower 30-day mortality than other general surgeons (11.8% vs. 15.2%), but this difference was not significant after multivariable adjustment (P=0.380).
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