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Can Acute Care Surgeons Perform Emergency Colorectal Procedures With Good Outcomes?

Schuster, Kevin M. MD; McGillicuddy, Edward A. MD; Maung, Adrian A. MD; Kaplan, Lewis J. MD; Davis, Kimberly A. MD

The Journal of Trauma: Injury, Infection, and Critical Care: July 2011 - Volume 71 - Issue 1 - p 94-101
doi: 10.1097/TA.0b013e31821e43d2
Original Article

Background: Acute care surgeons (ACS) perform emergency colorectal procedures but may have lower case volumes when compared with their general surgical and colorectal colleagues, which may compromise outcomes. In the acute populations, the elderly may be at particular risk.

Methods: Records of all elderly patients (age >65 years) presenting to a tertiary center with a colorectal emergency requiring operation over a 7-year period were reviewed. Data abstracted included presenting characteristics, pre- and postoperative diagnosis, procedural details, surgeon, and outcomes. Surgeons were stratified based on the number of elective colorectal cases they performed over the same time period. Chi-square test, Fisher's exact test, and t test were used, and logistic regression models controlled for patient characteristics. p < 0.05 was significant.

Results: There were 293 emergent colorectal operations. Mortality before stratification for perioperative risk factors was 15% (43 of 293). ACS mortality was higher than other surgeons (23.2% versus 12.4%; odds ratio, 2.14; p = 0.034). Length of stay, intensive care unit length of stay, and ventilator days were longer for ACS although not significant. On risk stratification by multivariate analysis preoperative hypotension, American Society of Anesthesiology class, age, time to operating room, and management with an open abdominal technique predicted mortality but surgeon type did not.

Conclusions: ACS caring for colorectal emergencies encounter critically ill patients with significant comorbidities, often from extended care facilities. If patient characteristics are considered when scrutinizing outcomes of emergency colorectal procedures, ACS perform as well as their colleagues who perform a higher volume of elective resections.

From the Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

Submitted for publication September 23, 2010.

Accepted for publication April 6, 2011.

Presented at the 69th Annual Meeting of the American Association for the Surgery of Trauma, September 22–25, 2010, Boston, Massachusetts.

Address for reprints: Kevin M. Schuster, MD, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, BB310, New Haven, CT 06520; email: kevin.schuster@yale.edu.

© 2011 Lippincott Williams & Wilkins, Inc.