Consultant versus trainee led surgery and impact on outcome following an emergency colonic resection.

Purpose: Emergency colonic surgery carries a high mortality rate. In the UK, strategies to improve outcomes in emergency general surgery recommend a consultant surgeon to be physically present during all operations involving a patient with a predicted mortality > 5%. To test the assertion of the consultant surgeon's presence in theatre as a determinate of improved outcome, we assessed patients following an emergency colonic resection and the effect of operator seniority.

Methods: A retrospective analysis was undertaken for all patients undergoing an emergency colonic resection during a 4-year period between 2013 and 2017. Patient's pre-operative risk was assessed using P-POSSUM score and ASA grade. Outcomes assessed were post-operative morbidity (recorded using Clavien-Dindo classification), 30 day/inpatient mortality and length of stay (LOS). Outcomes were then compared between consultant and trainee led cases using univariate logistic regression techniques with results presented in terms of odds ratios (95% confidence intervals). A p value of 0.05 is used to determine statistical significance.

Results: A total of 130 patients were identified over the 4-year study period. 65% had their operation performed by a consultant and 35% by a trainee. Pre-operative P-POSSUM scores were the same between the groups (9.4% [5.0-25.2] vs 9.4% [4.9-28.6] p 0.75). There was no significant difference in post-operative complication rates between consultant and trainee led cases for minor (OR 1.58 [0.76-3.20] p 0.27) or major complications (OR 1.08 [0.50-2.31] p 0.84). Overall post-operative mortality was 14% with a trend for higher mortality rates in consultant led cases (15% vs 9%) albeit not statistically significant (p 0.57). Despite similar complication rates, trainee led operations were associated with slightly longer LOS at 19 (IQR 12-38) vs 15 (IQR 9-23) days (p 0.56).

Conclusion: Emergency colonic surgery remains associated with a high level of morbidity and mortality. However, consultant presence at the operating table does not appear to be the sole determinant of outcome following an emergency colonic resection.