Equivalent Operative Outcomes for Emergency Colon Cancer Resections Among Acute Care Surgeons and Specialists in Colorectal Surgery

Comparison of perioperative outcomes of emergency hartmann resections performed by residents versus attending surgeons

OBJECTIVE

The optimal level of resident autonomy in emergency colorectal surgery is unclear. This study assessed perioperative outcomes in patients undergoing emergency colectomy with end stoma based on the presence of an attending surgeon.

PARTICIPANTS

A retrospective analysis was conducted at a tertiary teaching hospital, including 360 patients who underwent emergency colectomy with end stoma between 2013 and 2023. The primary outcome was perioperative complications, including mortality.

RESULTS

Of the 360 patients, 36 (10 ​%) had surgery without an attending surgeon present. Baseline characteristics such as age (p ​= ​0.34), Charlson Comorbidity Index (p ​= ​0.313), and sex (p ​= ​0.598) were similar across groups. Perioperative outcomes showed no significant differences in major complications (Clavien-Dindo ≥3, p ​= ​0.176), 90-day complication rate (p ​= ​0.698), or 90-day mortality (p ​= ​0.389). Malignancy-related cases also did not differ in lymph node yield (p ​= ​0.685) or overall survival (log-rank p ​= ​0.574).

CONCLUSION

In this study, Hartmann resections performed by resident teams were not associated with worse perioperative or oncologic outcomes, suggesting that resident autonomy can be safely increased without compromising patient safety.

Impact of surgical specialization on long-term survival after emergent colon cancer resections

BACKGROUND

The impact of surgical specialization on long-term survival in patients undergoing emergent colon cancer resections remains unclear.

METHOD

A retrospective analysis was conducted on all patients who underwent emergent colon cancer resections at a secondary care hospital between 2010 and 2020. The most senior surgeon performing the procedures was classified as colorectal surgeon (CS) or non-colorectal surgeon (NCS). NCS was further divided into acute care surgeons (ACSs) or general surgeons (GSs). Overall survival (OS) and cancer-free survival (CFS) were compared in patients operated by surgeons with different specializations.

RESULTS

A total of 235 emergent resections were performed during the study period, of which 99 (42%) were performed by CS and 136 (58%) by NCS. In adjusted Cox regression analyses, OS and CFS were similar in patients operated on by CS and NCS (hazard ratio (HR) for OS: 1.02 (0.72-1.496), p = 0.899 and HR for CFS: 0.91 (0.61-1.397), p = 0.660). Similarly, OS and CFS were equivalent in patients operated by ACS and CS (HR for OS: 1.10 (0.75-1.62), p = 0.629 and HR for CFS: 1.24 (0.80-1.92), p = 0.343). However, patients operated by GS had significantly shorter OS and CFS (HR for OS: 1.78 (1.05-3.00), p = 0.031 and HR for CFS: 1.83 (1.02-3.26), p = 0.041) compared with those operated by ACS and CS.

CONCLUSION

Long-term survival after emergent colon cancer resections was similar in patients operated on by CS and NCS, and the subgroup of ACS, indicating equivalent comparable surgical quality. The less favorable poorer survival observed for patients operated on by GS may possibly be due to less frequent exposure to colorectal and emergent surgery.

Effects of surgeon specialization on the outcome of emergency colorectal surgery

Background

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.

Materials and methods

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.

Results

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 [n=45, 67.2%] while the most common procedure performed by NCRS 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 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].

Conclusion

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.

Short- and long-term outcome after colon cancer resections performed by male and female surgeons: A single-center retrospective cohort study

BACKGROUND AND OBJECTIVE

To assess the effect of surgeon sex on short- and long-term outcomes after colon cancer resections.

METHODS

Clinical data of patients who underwent colon cancer resections between 2010 and 2020 at Helsingborg Hospital, Sweden, were retrospectively obtained from medical records. The sex of the surgeon of each procedure was recorded. Morbidity, mortality, and long-term survival were compared in patients operated by male and female surgeons.

RESULTS

Colon cancer resections were performed by 23 male and 9 female surgeons in 1113 patients (79% elective, 21% emergent). After elective surgery, there was no difference in postoperative complications, 30-day mortality, or long-term survival between patients operated by male and female surgeons. Following emergent resections, the complication rate was significantly lower in patients operated by female surgeons (41.3% vs 58.1%, p = 0.019). Similarly, the rates of R1-resections (0% vs 5.2%, p = 0.039), reoperations (3.8% vs 14.2%, p = 0.014), and intensive care unit (ICU) care (6.3% vs 17.4%, p = 0.018) were significantly lower for patients operated by female surgeons, but there was no difference in 30-day mortality (6.3% vs 5.2%, p = 0.767). Cox regression analysis showed that long-term and cancer-free survival in patients emergently operated by male surgeons was significantly shorter than that of patients operated by female surgeons (hazard ratio = 1.9 (95% confidence interval (CI) = 1.3-2.8), p = 0.001 and hazard ratio = 1.7 (95% CI = 1.1-2.7), p = 0.016).

CONCLUSIONS

The short- and long-term outcome after elective colon cancer resections were similar in patients operated by male and female surgeons. The outcome following emergent resections performed by female surgeons compared favorably with that of male surgeons, with fewer complications and reoperations and better long-term survival.

Application Value of High-Quality Nursing in Operating Room in Rectal Cancer Operation and its Influence on Postoperative Rehabilitation

OBJECTIVE

To study the value of high-quality care in operating room during operation of patients with rectal cancer and the effect of this nursing model on postoperative rehabilitation.

METHODS

This study recruited 72 patients with rectal cancer, including 36 in the control group and 36 in the observation group. Patients in the control group received routine care, and those in the observation group received high-quality care in operating room.

RESULTS

The anxiety score (5.50 ± .77 vs 10. 08 ± 1.13), stress score (6.97 ± .60 vs 8.61 ± .99), and depression score (4.02 ± .65 vs 5.50 ± .91) in the observation group were less than the control group after treatment (P < .05). The measured values of diastolic blood pressure (73.19 ± 1.96 vs 86.13 ± 2.0), systolic blood pressure (121.08 ± 1.62 vs 130.63 ± 2.84), heart rate (73.05 ± 1.63 vs 87.11 ± 2.91) and adrenaline E(E) (58.40 ± 3.02 vs 61.42 ± 3.86) in the observation group were less than the control group after treatment (P < .05). The cooperation degree (94.44 vs 75.00) in the observation group was greater than the control group, but the operation time (308.47 ± 9.92 vs 339.47 ± 12.70), postoperative intestinal function recovery time (16.30 ± 1.14 vs 30.94 ± 2.10) and length of stay (10.47 ± 1.85 vs 13.33 ± 1.95) were all shorter than the control group (P < .05). The nasopharyngeal temperature in the observation group was greater than the control group at 30 minutes during operation (36.16 ± .50 vs 35.19 ± .40) and after operation, and fear score (2.22 ± .42 vs 3.63 ± .72) was less than the control group (P < .05).

CONCLUSION

The application of high-quality care in the operating room during rectal cancer surgery has a significantly good clinical outcome.

Surgical Science and the Evolution of Critical Care Medicine

Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.