Bunjo Zachary, Traeger Luke, Murshed Ishraq, Bedrikovetski Sergei, Dudi-Venkata Nagendra N, Dobbins Christopher, Sammour Tarik
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Dis Colon Rectum. 2025 Jan 1;68(1):14-30. doi: 10.1097/DCR.0000000000003418. Epub 2024 Oct 22.
Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality.
Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery.
Systematic searches of Ovid MEDLINE, Ovid Embase, and Cochrane electronic databases were performed for studies published from January 1, 1990, to August 27, 2023.
Studies investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against noncolorectal surgeon specialization, were included. Exclusion criteria were: 1) publications studying primarily pediatric populations; 2) studies incorporating patients who had undergone surgery before 1990; and 3) studies only published in abstract form or non-English language.
Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach.
Of 7676 studies identified, 155 were selected for full-text review and 21 were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64; 95% CI, 0.60-0.68; p < 0.0001) and in-hospital mortality (OR 0.66; 95% CI, 0.49-0.89; p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95; 95% CI, 2.02-4.31; p < 0.0001) and use of laparoscopic surgery (OR 2.38; 95% CI, 1.42-4.00; p = 0.001) among specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52; 95% CI, 0.28-0.98; p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70; 95% CI, 0.45-1.07; p = 0.10) or reintervention rates (OR 0.78; 95% CI, 0.55-1.10; p = 0.16).
Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries.
Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved postoperative mortality, lower rates of stoma formation, and increased rates of primary anastomosis and minimally invasive surgery.
CRD42022300541.
结直肠急症在急性普通外科工作量中占很大比例，且死亡率很高。
确定外科医生专业化对急诊结直肠手术死亡率和其他结局的影响。
对Ovid MEDLINE、Ovid Embase和Cochrane电子数据库进行系统检索，以查找1990年1月1日至2023年8月27日发表的研究。
纳入研究成人急诊结直肠手术结局、比较结直肠外科医生与非结直肠外科医生专业化的研究。排除标准为：1）主要研究儿科人群的出版物；2）纳入1990年前接受过手术患者的研究；3）仅以摘要形式发表或使用非英语语言的研究。
主要结局为30天死亡率和住院死亡率。次要结局为吻合口漏发生率、再次干预率、一期吻合率和腹腔镜手术入路率。
在检索到的7676项研究中，155项被选进行全文审查，21项被纳入定量分析。11项研究显示，结直肠外科专业化可改善30天死亡率（OR 0.64；95%CI，0.60 - 0.68；p < 0.0001）和住院死亡率（OR 0.66；95%CI，0.49 - 0.89；p = 0.007）。结直肠专科医生进行一期吻合（OR 2.95；9%CI，2.02 - 4.31；p < 0.0001）和使用腹腔镜手术（OR 2.38；95%CI，1.42 - 4.00；p = 0.001）的比例显著更高。专业化还与任何造口形成的显著减少相关（OR 0.52；95%CI，0.28 - 0.98；p = 0.04）。吻合口漏（OR 0.70；95%CI，0.45 - 1.07；p = 0.10）或再次干预率（OR 0.78；95%CI，0.55 - 1.10；p = 0.16）未观察到显著差异。
纳入的患者群体以及不同国家观察到的结直肠专业化定义存在异质性。
由结直肠专科医生进行的急诊结直肠手术与术后死亡率显著改善、造口形成率降低以及一期吻合率和微创手术率增加相关。
PROSPERO注册编号：CRD42022300541。
