Effects of surgeon specialization on the outcome of emergency colorectal surgery

Abstract

Background: Colonic emergencies remain a major life-threatening condition associated with high morbidity and mortality rates. Unlike elective colorectal surgical procedures, a large portion of emergency colorectal surgical procedures are performed by noncolorectal surgeons (NCRS). The impact of specialization on the outcome of emergency colorectal surgery has not yet been well described. The authors aimed to evaluate the impact of surgeon specialization on the outcomes of emergency colorectal surgeries.

Materials and methods: A retrospective cohort study conducted in a tertiary care center in Riyadh, Saudi Arabia between July 2008 to July 2020. Patients underwent emergency colorectal surgeries and met study inclusion criteria were identified and grouped according to the specialty of the primary surgeon: colorectal surgeons [CRS] or NCRS. Relevant study data was obtained from patient medical files. Bivariate and multivariate regression analyses were used to assess the association between the surgeons' specialty and outcomes.

Results: Of 219 included patients, there were 126 men [57.5%] and 93 women [42.4%]. Of all population 128 patients [58%] were operated on by CRS while 91 patients [42%] were operated on by NCRS. Most common procedure performed by CRS was left hemicolectomy [n=45, 67.2%] while the most common procedure performed by NCRS was right hemicolectomy [n=26, 51%]. The most common reason for surgery was malignant pathologies [n=129, 58.9%]. Patients who had their surgeries performed by a CRS had a significant decrease in 30-day mortality [odds ratio [OR] 0.23, 95% CI: 0.065-0.834]. Reoperation also decreased in this group [OR 0.413, 95% CI: 0.179-0.956]. Moreover, both hospital length of stay and ICU length of stay decreased CRS compared with the NCRS [OR 0.636, 95% CI: 0.465-0.869, and OR 0.385, 95% CI: 0.235-0.63, respectively].

Conclusion: Specialization in colorectal surgery has a significant influence on morbidity and mortality after emergency operations. These findings may in improving emergency services and support remodeling the referral system in the institutions.

Keywords: colorectal; emergency; surgeon.