Key result
Discordant surgeon specialist interest has no impact on 30-day mortality after adjustment.
Why the study?
Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, raising questions about local impact and service configuration.
Does declared surgeon specialist interest influence the outcome of emergency laparotomy in adult patients?
Cohort (n=600)
No
Does declared surgeon specialist interest influence the outcome of emergency laparotomy in adult patients?
Odds Ratio: 2.34 (95% CI 1.1–5)
p-value: p=0.003
Surgeon-declared specialty does not impact emergency laparotomy outcomes when adjusted for confounders, likely reflecting collaborative on-call structures.
Surgeon specialty shows no adjusted impact on emergency laparotomy outcomes; supports collaborative on-call models but leaves generalizability open.
Introduction In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. Methods Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. Results Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10–5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. Conclusion Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.
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Hallam et al. (2020) conducted a cohort in Emergency laparotomy (n=600). Discordant declared surgeon specialist interest vs. Concordant declared surgeon specialist interest was evaluated on 30-day mortality (OR 2.34, 95% CI 1.10-5.00, p=0.003). Discordant declared surgeon specialist interest had no impact on 30-day mortality after multivariate adjustment, despite an unadjusted increased risk (OR 2.34; 95% CI 1.10-5.00; p=0.003).
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