Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-Analysis

• Published in: Diseases of the colon & rectum
• Main Authors: Bunjo, Zachary, Traeger, Luke, Murshed, Ishraq, Bedrikovetski, Sergei, Dudi-Venkata, Nagendra, Dobbins, Christopher, Sammour, Tarik
• Format: Journal Article
• Language: English
• Published: 22.10.2024
• ISSN: 0012-3706; 1530-0358; 1530-0358
• DOI: 10.1097/DCR.0000000000003418

Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality.BACKGROUNDColorectal 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.OBJECTIVEIdentify 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 1 January 1990 to 27 August 2023.DATA SOURCESSystematic searches of Ovid MEDLINE, Ovid EMBASE, and Cochrane electronic databases were performed for studies published from 1 January 1990 to 27 August 2023.Studies were included investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against non-colorectal surgeon specialization. Exclusion criteria were: (1) publications studying primarily pediatric populations; (2) studies incorporating patients who had undergone surgery prior to 1990; (3) studies only published in abstract form or non-English language.STUDY SELECTIONStudies were included investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against non-colorectal surgeon specialization. Exclusion criteria were: (1) publications studying primarily pediatric populations; (2) studies incorporating patients who had undergone surgery prior to 1990; (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.MAIN OUTCOME MEASURESPrimary 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 studies 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) amongst 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).RESULTSOf 7676 studies identified, 155 were selected for full-text review and 21 studies 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) amongst 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.LIMITATIONSHeterogeneity 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 post-operative mortality, lower rates of stoma formation and increased rates of primary anastomosis and minimally invasive surgery.CONCLUSIONSEmergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved post-operative mortality, lower rates of stoma formation and increased rates of primary anastomosis and minimally invasive surgery.CRD42022300541.PROSPERO REGISTRATIONCRD42022300541.