TP6.2.4 Emergency colorectal resections: do colorectal surgeons achieve better outcomes than non-colorectal surgeons?

Abstract

Abstract Aim Patients requiring emergency colorectal surgery in Tayside are managed by general surgeons who may or may not have subspecialist training in colorectal surgery. We investigated whether surgeon subspecialisation influences outcomes after emergency colorectal resections. Methods All patients undergoing emergency colorectal resections between 01/01/14 and 31/10/20 were included. Demographic, clinical, operative and outcome data were collected from hospital electronic records. Outcomes were compared for patients treated by colorectal versus non-colorectal surgeons. The primary outcome was 30-day post-operative mortality. Adjusted mortality was calculated using logistic regression. Secondary outcomes included rates of laparoscopic surgery, stomas, complications, readmissions and length of hospital stay. Categorical data were compared by chi-squared tests and non-parametric data by Wilcoxon tests. Results Of the 177 operations performed, 104 (58.8%) were performed by colorectal surgeons. Overall 30 day mortality was 5.1%, which was significantly lower for colorectal versus non-colorectal surgeons (1.0% vs 11.0%, p = 0.003), this remained significant after multivariate adjustment (Odds ratio 0.10, 95% confidence interval 0.01-0.86, p = 0.036). The proportion of laparoscopic cases was significantly higher for colorectal compared with non-colorectal surgeons (54.8% vs 4.1%, p < 0.0001). There were no significant differences in stoma rates (76.0% vs 63.0%, p = 0.063), further procedures (5.8% vs 8.2%, p = 0.523), anastomotic leaks (1.9% vs 4.1%, p = 0.387), readmission within 30 days (12.5% vs 13.7%, p = 0.815) or median length of hospital stay (16 vs 18 days, p = 0.375). Conclusion Mortality rates at 30 days after emergency colorectal surgery are significantly lower for patients treated by subspecialist colorectal surgeons. This provides a strong argument for a subspecialist on-call rota.