Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
Division of Colon and Rectal Surgery, Columbia University, New York, New York.
Dis Colon Rectum. 2019 Jan;62(1):79-87. doi: 10.1097/DCR.0000000000001230.
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.
The purpose of this study was to determine whether subspecialty training in colorectal surgery is associated with differences in postoperative outcomes after emergency colectomy.
This was a retrospective cohort study.
Three tertiary care hospitals participating in the National Surgical Quality Improvement Project were included.
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.
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.
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).
This study was limited by its retrospective design, with potential selection bias attributed to referral patterns.
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.
高手术量的外科医生与术后改善结果之间的关系已得到充分证实。结直肠手术通常由普通外科医生完成，尤其是在紧急情况下，并且可能构成其大部分实践内容。然而，专门化培训对紧急结肠手术后结果的影响尚未得到很好的描述。
本研究旨在确定结直肠外科专业培训是否与急诊结肠切除术后的术后结果存在差异。
这是一项回顾性队列研究。
参与国家手术质量改进计划的三家三级保健医院被纳入研究。
在每家医院均确定接受紧急结肠切除术的患者，并根据涉及结直肠外科医生、普通外科医生或急性护理外科医生进行分层。
采用倾向评分匹配来分离外科医生专业对主要结局（包括术后发病率、死亡率、住院时间以及计划外再次主要手术的需求）的影响，以比较两组患者。
共确定了 889 例患者，其中 592 例由结直肠外科医生进行手术，297 例由普通/急性护理外科医生进行手术。在进行倾向评分匹配后，由结直肠外科医生进行手术的病例 30 天死亡率（6.7%比 16.4%；p=0.001）、术后发病率（45.0%比 56.7%；p=0.009）和计划外再次主要手术（9.7%比 16.4%；p=0.04）的发生率显著更低。此外，由普通/急性护理外科医生进行手术的患者的住院时间延长了约 4.4 天（p<0.001）。
该研究受到回顾性设计的限制，可能存在归因于转诊模式的选择偏倚。
在控制潜在疾病状态和疾病严重程度后，与非结直肠外科医生相比，结直肠外科医生进行的紧急结肠切除术与术后发病率和死亡率的显著降低相关。这些发现可能对机构的转诊模式产生影响。详见视频摘要，网址：http://links.lww.com/DCR/A767。
