Subspecialist emergency management of diverticulitis is associated with reduced mortality and fewer stomas

Boyce, Stephen; Bartolo, D. C. C.; Paterson, Hugh

doi:10.1111/codi.12022

Cited by 33 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Boyce et al in 2013 studied the impact of introducing a regional emergency subspecialty colorectal unit in Scotland and found that colorectal surgeons were more likely to perform primary anastomosis after emergency resection than general surgeons (68.4 versus 41.6%, P < 0.0001). 16 The emergency operative intervention rate was signifi-cantly higher than our study at 27%. This may be attributed to a more aggressive operative approach during their study time period.…”

Section: Discussioncontrasting

confidence: 66%

Operative intervention rates for acute diverticulitis: a multicentre state‐wide study

Hong

Tomlin

Hayes

et al. 2015

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 66%

Operative intervention rates for acute diverticulitis: a multicentre state‐wide study

Hong

Tomlin

Hayes

et al. 2015

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Biondo and colleagues investigated the impact of surgical specialization on patients having emergency colorectal surgery, and concluded that specialization in colorectal surgery improved morbidity, mortality and complication rates. Boyce and co‐workers reported decreased mortality and complication rates in patients who had emergency operations for diverticulitis performed by surgeons with a colorectal special interest; however, there was no evidence of risk adjustment in their analysis.…”

Section: Discussionmentioning

confidence: 96%

Association between surgeon special interest and mortality after emergency laparotomy

Boyd-Carson

Doleman

Herrod

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…18 It is interesting that these data suggest that 30-day mortality appeared significantly lower if emergency colonic resection is performed by subspecialist colorectal surgeons rather than non-colorectal specialists. Significantly better postoperative morbidity, 19,20 mortality, 20,21 stoma rate, 19,21 primary anastomosis rate 21 and anastomotic leak rate 20 have been reported previously for those emergency colorectal cases operated on by colorectal subspecialists. The unadjusted data from this study are best regarded as preliminary.…”

Section: Discussionmentioning

confidence: 55%

Current UK practice in emergency laparotomy

Barrow¹,

Anderson²,

Varley³

et al. 2013

annals

View full text Add to dashboard Cite

on behalf of the UK Emergency Laparotomy Network ABStRAct INTRODUCTION Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. METHODS Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. RESULTS Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. CONCLUSIONS This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

show abstract

Subspecialist emergency management of diverticulitis is associated with reduced mortality and fewer stomas

Abstract: Emergency management of diverticulitis by subspecialist colorectal surgeons is associated with low overall and operative mortality whilst safely achieving high rates of primary anastomosis.

Cited by 33 publications

References 21 publications

Operative intervention rates for acute diverticulitis: a multicentre state‐wide study

Operative intervention rates for acute diverticulitis: a multicentre state‐wide study

Association between surgeon special interest and mortality after emergency laparotomy

Current UK practice in emergency laparotomy

Contact Info

Product

Resources

About