Alselaim Nahar A, AlAamer Ohood H, Almalki Mohammed M, Al-Osail Abdualziz A, Bin Gheshayan Sultanah F
College of Medicine, King Saud bin AbdulAziz university for Health Sciences, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
Ann Med Surg (Lond). 2024 Nov 13;86(12):7010-7015. doi: 10.1097/MS9.0000000000002685. eCollection 2024 Dec.
Colonic emergencies remain a major life-threatening condition associated with high morbidity and mortality rates. Unlike elective colorectal surgical procedures, a large portion of emergency colorectal surgical procedures are performed by noncolorectal surgeons (NCRS). The impact of specialization on the outcome of emergency colorectal surgery has not yet been well described. The authors aimed to evaluate the impact of surgeon specialization on the outcomes of emergency colorectal surgeries.
A retrospective cohort study conducted in a tertiary care center in Riyadh, Saudi Arabia between July 2008 to July 2020. Patients underwent emergency colorectal surgeries and met study inclusion criteria were identified and grouped according to the specialty of the primary surgeon: colorectal surgeons [CRS] or NCRS. Relevant study data was obtained from patient medical files. Bivariate and multivariate regression analyses were used to assess the association between the surgeons' specialty and outcomes.
Of 219 included patients, there were 126 men [57.5%] and 93 women [42.4%]. Of all population 128 patients [58%] were operated on by CRS while 91 patients [42%] were operated on by NCRS. Most common procedure performed by CRS was left hemicolectomy [=45, 67.2%] while the most common procedure performed by NCRS was right hemicolectomy [=26, 51%]. The most common reason for surgery was malignant pathologies [=129, 58.9%]. Patients who had their surgeries performed by a CRS had a significant decrease in 30-day mortality [odds ratio [OR] 0.23, 95% CI: 0.065-0.834]. Reoperation also decreased in this group [OR 0.413, 95% CI: 0.179-0.956]. Moreover, both hospital length of stay and ICU length of stay decreased CRS compared with the NCRS [OR 0.636, 95% CI: 0.465-0.869, and OR 0.385, 95% CI: 0.235-0.63, respectively].
Specialization in colorectal surgery has a significant influence on morbidity and mortality after emergency operations. These findings may in improving emergency services and support remodeling the referral system in the institutions.
结肠急症仍然是一种严重威胁生命的疾病，发病率和死亡率都很高。与择期结直肠手术不同，大部分急诊结直肠手术是由非结直肠外科医生（NCRS）进行的。专业化对急诊结直肠手术结果的影响尚未得到充分描述。作者旨在评估外科医生专业化对急诊结直肠手术结果的影响。
在沙特阿拉伯利雅得的一家三级医疗中心进行了一项回顾性队列研究，时间为2008年7月至2020年7月。对接受急诊结直肠手术且符合研究纳入标准的患者进行识别，并根据主刀医生的专业进行分组：结直肠外科医生[CRS]或NCRS。相关研究数据从患者病历中获取。采用双变量和多变量回归分析来评估外科医生专业与手术结果之间的关联。
在纳入的219例患者中，男性126例[57.5%]，女性93例[42.4%]。在所有患者中，128例[58%]由CRS进行手术，而91例[42%]由NCRS进行手术。CRS最常进行的手术是左半结肠切除术[=45，67.2%]，而NCRS最常进行的手术是右半结肠切除术[=26，51%]。最常见的手术原因是恶性病变[=129，58.9%]。由CRS进行手术的患者30天死亡率显著降低[比值比[OR]0.23，95%可信区间：0.065 - 0.834]。该组再次手术率也降低了[OR 0.413，95%可信区间：0.179 - 0.956]。此外，与NCRS相比，CRS组的住院时间和重症监护病房住院时间均缩短[分别为OR 0.636，95%可信区间：0.465 - 0.869，以及OR 0.385，95%可信区间：0.235 - 0.63]。
结直肠外科专业化对急诊手术后的发病率和死亡率有显著影响。这些发现可能有助于改善急诊服务，并支持机构内转诊系统的重塑。
