SP1.4 Evaluating the impact of increased sub-specialist cover on NELA outcomes: A retrospective single centre study

Aims

Emergency general surgery is managed by upper gastrointestinal (UGI) and colorectal surgeons. Outcomes are improved when emergency procedures are within the specialty of the surgeon. This study evaluates the impact of surgeon specialisation and increased consultant cross-cover on patient outcomes.

Methods

The local NELA database was analysed between November 2013 and May 2022. Procedures were classified into UGI, colorectal, or general. Comparison was made between procedures performed within or outside of surgeon sub-specialty and before and after a modified consultant rota was introduced. Primary outcome was 30-day mortality.

Results

A total of 1,313 NELA procedures were performed (90 UGI, 606 colorectal, 617 general); 167 (13%) procedures were performed outside the surgeon sub-speciality. Mortality was lower following procedures within sub-specialty (7.6% vs 12.6%, p=.029). Mortality was lower following colorectal operations performed by colorectal surgeons (colorectal 6.8% vs UGI; 14.0%, p=.01). Multivariate analysis demonstrated that procedures within a surgeon sub-specialty were still associated with lower mortality (OR 0.76, p<0.01) when urgency of operation was accounted for.

In 2019, following addition of cross-cover in the consultant rota, the number of operations performed outside of sub-specialty was reduced (2013-2019; 15.4% vs 2019-2022; 9.8%, p=.05). Across the data collection period mortality decreased overall (2013-2019; 10.0% vs 2019-2022; 6.5%, p<0.01). There was a trend towards decreased mortality following operations outside the surgeon sub-specialty (2013-2019, 14.4%, 2019-2022, 8.9%, p=0.32).

Conclusion

Mortality following laparotomy is reduced when the procedures are within the sub-specialty of the operating surgeon. Rota changes to allow sub-speciality cover can improve peri-operative mortality.