Health Education England North East, Waterfront 4 Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne, NE15 8NY, UK.
Health Education England North East, Waterfront 4 Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne, NE15 8NY, UK.
Int J Surg. 2019 Feb;62:67-73. doi: 10.1016/j.ijsu.2019.01.010. Epub 2019 Jan 20.
General surgeons have become increasingly subspecialised in their elective practice. Emergency laparotomies, however, are performed by a range of subspecialists who may or may not have an interest in the affected area of gastrointestinal tract. This retrospective cohort study evaluates the impact of surgical subspecialisation on patient outcomes following emergency laparotomy.
Data was collected for patients who underwent an emergency abdominal procedure on the gastrointestinal tract in the North of England from 2001 to 2016. This included demographics, co-morbidities, diagnoses and procedures undertaken. Patients were grouped according to consultants' subspecialist interest. The primary outcome of interest was 30-day postoperative mortality.
24,291 emergency laparotomies were performed with an associated 30-day postoperative mortality of 11.7%. Laparotomies undertaken by upper gastrointestinal (UGI) or colorectal surgeons have significantly lower mortality (10.1%) when compared with other subspecialities (13.5%). More specifically, mortality was decreased for UGI (7.9% vs. 12.9%) and colorectal procedures (10.9% vs. 14.2%) when performed by surgeons with a specialist interest in the relevant area of the gastrointestinal tract (both p < 0.001). The utilisation of laparoscopic surgery is higher, in both UGI (21.8% vs. 9.0%) and colorectal procedures (7.2% vs. 3.5%), when the causative pathology is relevant to the surgeon's subspeciality (both p < 0.001).
Mortality following emergency laparotomy is improved when performed under the care of gastrointestinal surgeons. Both UGI and colorectal emergency procedures have improved outcomes, with lower mortality and higher rates of laparoscopy, when under the care of a surgeon with a subspecialist interest in the affected area of the gastrointestinal tract.
普通外科医生在其选择性实践中变得越来越专业化。然而，急诊剖腹手术由一系列可能对胃肠道受影响区域有兴趣或没有兴趣的亚专科医生进行。本回顾性队列研究评估了手术专业化对急诊剖腹手术后患者结局的影响。
收集了 2001 年至 2016 年在英格兰北部接受胃肠道急诊腹部手术的患者数据。这些数据包括人口统计学、合并症、诊断和进行的手术。根据顾问的亚专科兴趣将患者分为不同的组。主要关注的结果是 30 天术后死亡率。
共进行了 24291 例急诊剖腹手术，术后 30 天死亡率为 11.7%。与其他亚专科相比，上消化道 (UGI) 或结直肠外科医生进行的剖腹手术死亡率显著降低 (10.1%)。更具体地说，当相关领域的外科医生具有专业兴趣时，UGI（7.9% 比 12.9%）和结直肠手术（10.9% 比 14.2%）的死亡率降低（均 p<0.001）。当病因病理学与外科医生的亚专科相关时，UGI（21.8% 比 9.0%）和结直肠手术（7.2% 比 3.5%）中腹腔镜手术的使用率更高（均 p<0.001）。
在胃肠道外科医生的护理下进行急诊剖腹手术时，死亡率得到改善。当受影响的胃肠道区域的外科医生具有专业兴趣时，UGI 和结直肠急诊手术的结果都得到改善，死亡率降低，腹腔镜手术的比例更高。
