Association between surgeon special interest and mortality after emergency laparotomy

Boyd-Carson, H; Doleman, Brett; Herrod, Philip; Anderson, I. D.; Williams, John P.; Lund, Jonathan N.; Tierney, Gillian

doi:10.1002/bjs.11146

Cited by 36 publications

(36 citation statements)

References 24 publications

(23 reference statements)

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“…Whilst outcomes have improved over time, ongoing research continues to highlight potential contributing factors that may affect the morbidity and mortality observed following emergency surgery. Ideas such as the ‘weekend effect’ [6], the effects of frailty [7] and the impact of subspecialization have all been studied within general surgery [8,11,31]. Of the 24 328 patients assessed in the latest NELA report, colorectal emergency resections accounted for three of the five most commonly performed procedures [5].…”

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confidence: 99%

The impact of surgical subspecialization on patient outcomes following emergency colorectal resections in the north of England: a retrospective cohort study

et al. 2020

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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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Section: Discussionmentioning

confidence: 99%

The impact of surgical subspecialization on patient outcomes following emergency colorectal resections in the north of England: a retrospective cohort study

et al. 2020

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“…We read with interest the study by Boyd et al . which found an increase in mortality in colorectal and upper gastrointestinal (GI) emergency laparotomy performed by non‐specialist surgeons.…”

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“…We aim to conduct future research in our unit to see if the findings of this study are applicable to local setting.…”

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Comment on: Association between surgeon special interest and mortality after emergency laparotomy

Chia

Lee

Goo

2020

British Journal of Surgery

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“…Ramsay et al's study on the reduction of mortality after surgery in Scotland continued to stimulate debate about the role that the WHO checklist played in this effect 5 . Boyd-Carson et al's study on the association between surgeon special interest and mortality after emergency laparotomy continued to have a high impact on Twitter 6 . @kmahawar commented that when non-gastrointestinal (GI) surgeons were removed from the analysis, there was no increased risk of return to theatre for either upper GI or colorectal procedures, and suggested that this was because patients died of non-surgical complications.…”

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Grossman

2019

British Journal of Surgery

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Association between surgeon special interest and mortality after emergency laparotomy

Abstract: on behalf of the NELA Collaboration Br J Surg 2019; 106: 940-948.

Cited by 36 publications

References 24 publications

The impact of surgical subspecialization on patient outcomes following emergency colorectal resections in the north of England: a retrospective cohort study

The impact of surgical subspecialization on patient outcomes following emergency colorectal resections in the north of England: a retrospective cohort study

Comment on: Association between surgeon special interest and mortality after emergency laparotomy

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