Abstract
Background: Colonic emergencies remain a major life-threatening condition associated with high morbidity and mortality rates. Many factors have been reported as significant risk factors for postoperative course outcome. Unlike elective colorectal surgical procedures, a large portion of emergency colorectal surgical procedures are performed by noncolorectal surgeons. The impact of specialization on the outcome of emergency colorectal surgery has not yet been well described. The objective was to evaluate the impact of surgeon specialization on the outcomes of emergency colorectal surgeries. Methods: This was a retrospective cohort study conducted at King Abdulaziz Medical City in Riyadh. Patients undergoing emergency colorectal surgery were identified and grouped according to the specialty of the primary surgeon: colorectal surgeon or noncolorectal surgeon. Outcomes included 30-day mortality, length of stay, intensive care unit (ICU) stay, 30-day complications and reoperation Bivariate and multivariate regression analyses were used to assess the association between the surgeons' specialty and outcomes. Results: Of 219 included patients who underwent surgery between 2008 and 2020, there were 126 men (57.5%) and 93 women (42.4%).The most common procedure performed by colorectal surgeons was left hemicolectomy (n = 45, 67.2%) while the most common procedure performed by noncolorectal surgeons was right hemicolectomy (n = 26, 51%). The most common reason for surgery was malignant pathologies (n = 129, 58.9%). Patients who had their surgeries performed by a colorectal surgeon had a significant decrease in 30-day mortality (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.065-0.834). Reoperation also decreased in this group (OR 0.413, 95% CI 0.179-0.956). In addition, both hospital length of stay and ICU length of stay decreased in the colorectal group compared with the noncolorectal group (OR 0.636, 95% CI 0.465-0.869, and OR 0.385, 95% CI 0.235-0.63, respectively). Conclusion: Specialization in colorectal surgery has a significant influence on morbidity and mortality after emergency operations. These findings may help improve emergency services and remodel referral systems in institutions.