Association between surgeon special interest and mortality after emergency laparotomy

Area of Science:

• Surgical outcomes research
• Gastrointestinal surgery
• Healthcare management

Background:

• Approximately 30,000 emergency laparotomies are performed annually in England and Wales.
• General surgeons manage these cases, often with elective special interests in upper or lower gastrointestinal tracts.
• The impact of surgeon specialization on emergency laparotomy outcomes requires investigation.

Purpose of the Study:

• To investigate the association between consultant surgeon special interest and mortality after emergency laparotomy.
• To analyze the effect of specialization on 30-day mortality, length of hospital stay, and return to theatre.

Main Methods:

• Retrospective analysis of adult patients undergoing emergency laparotomy for colorectal or gastroduodenal pathology from the National Emergency Laparotomy Audit database.
• Patients were grouped by operative procedure and consultant's special interest.
• Logistic and Poisson regression models were used to analyze outcomes.

Main Results:

• A total of 33,819 patients were included.
• Colorectal procedures by non-specialist surgeons were associated with increased 30-day mortality (OR 1.23) and return to theatre (OR 1.13).
• Upper gastrointestinal procedures by non-specialist surgeons showed increased 30-day mortality (OR 1.24), but not return to theatre.

Conclusions:

• Emergency laparotomy performed by surgeons lacking specific pathology interest carries a higher risk of 30-day mortality.
• Findings have significant implications for emergency service configuration, surgical training, and workforce planning.
• This underscores the importance of aligning surgical expertise with emergency patient needs.