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Emergent Colon Resections

Does Surgeon Specialization Influence Outcomes?

Kulaylat, Audrey S., M.D.1; Pappou, Emmanouil, M.D., Ph.D.2; Philp, Matthew M., M.D.3; Kuritzkes, Benjamin A., M.D.2; Ortenzi, Gail, R.N.1; Hollenbeak, Christopher S., Ph.D.1,4; Choi, Christine, M.D.1; Messaris, Evangelos, M.D., Ph.D.1

Diseases of the Colon & Rectum: January 2019 - Volume 62 - Issue 1 - p 79–87
doi: 10.1097/DCR.0000000000001230
Original Contributions: Socioeconomic
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BACKGROUND: Relationships between high-volume surgeons and improved postoperative outcomes have been well documented. Colorectal procedures are often performed by general surgeons, particularly in emergent settings, and may form a large component of their practice. The influence of subspecialized training on outcomes after emergent colon surgery, however, is not well described.

OBJECTIVE: The purpose of this study was to determine whether subspecialty training in colorectal surgery is associated with differences in postoperative outcomes after emergency colectomy.

DESIGN: This was a retrospective cohort study.

SETTINGS: Three tertiary care hospitals participating in the National Surgical Quality Improvement Project were included.

PATIENTS: Patients undergoing emergent colon resections were identified at each institution and stratified by involvement of either a colorectal surgeon or a general or acute care surgeon.

MAIN OUTCOME MEASURES: Propensity score matching was used to isolate the effect of surgeon specialty on the primary outcomes, including postoperative morbidity, mortality, length of stay, and the need for unplanned major reoperation, in comparable cohorts of patients.

RESULTS: A total of 889 cases were identified, including 592 by colorectal and 297 by general/acute care surgeons. After propensity score matching, cases performed by colorectal surgeons were associated with significantly lower rates of 30-day mortality (6.7% vs 16.4%; p = 0.001), postoperative morbidity (45.0% vs 56.7%; p = 0.009), and unplanned major reoperation (9.7% vs 16.4%; p = 0.04). In addition, length of stay was ≈4.4 days longer among patients undergoing surgery by general/acute care surgeons (p < 0.001).

LIMITATIONS: This study was limited by its retrospective design, with potential selection bias attributed to referral patterns.

CONCLUSIONS: After controlling for underlying disease states and illness severity, emergent colon resections performed by colorectal surgeons were associated with significantly lower rates of postoperative morbidity and mortality when compared with noncolorectal surgeons. These findings may have implications for referral patterns for institutions. See Video Abstract at http://links.lww.com/DCR/A767.

1 Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

2 Division of Colon and Rectal Surgery, Columbia University, New York, New York

3 Division of Colon and Rectal Surgery, Temple University, Philadelphia, Pennsylvania

4 Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Evangelos Messaris, M.D., Ph.D., The Pennsylvania State University, College of Medicine, Department of Surgery, 500 University Dr, H137, PO Box 850, Hershey, PA 17033-0850. E-mail: emessari@bidmc.harvard.edu

© 2019 The American Society of Colon and Rectal Surgeons