PURPOSE: The value of specialization has frequently been challenged by many health care institutions and providers. This review was conducted to determine whether there were any outcome differences in the management of fistulas complicating diverticulitis. METHODS: We conducted an historical cohort study using hospital charts of all cases of fistulas complicating diverticulitis that were operated on in four university-affiliated hospitals between 1975 and 1995. There were 122 patients, with 37 under the care of fully trained colorectal surgeons and 85 under the care of general surgeons. RESULTS: There were no significant differences in patient demographics, preoperative comorbidities, or the number of preoperative diagnostic investigations between the two groups. The colorectal surgeons performed more intraoperative ureteral stenting (Colorectal Surgery 55.5 percentvs. General Surgery 24.4 percent,P=0.001). The general surgeons performed more initial diverting Hartmann's and colostomy procedures (Colorectal Surgery 5.4 percentvs. General Surgery 27 percent,P=0.013). The patients in the General Surgery group had longer preoperative lengths of stay (median Colorectal Surgery 3 (range, 1–28) daysvs. General Surgery 8 (range, 0–29) days;P<0.001), longer postoperative lengths of stay (median Colorectal Surgery 11 (range, 5–40) daysvs. General Surgery 14 (range, 2–80) days;P=0.001), and longer total lengths of stay (median Colorectal Surgery 14 (range, 6–62) daysvs. General Surgery 24 (range, 6–100) days;P<0.001). The patients in the General Surgery group experienced a higher rate of wound infections (Colorectal Surgery 5.4 percentvs. General Surgery 12.9 percent), and a larger proportion of them experienced complications (Colorectal Surgery 27 percentvs. General Surgery 41.2 percent). CONCLUSIONS: We conclude that specialization in colon and rectal surgery contributed to an improved outcome, with a lower rate of diverting procedures, a shorter hospital stay, and a lower rate of complications.
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Kassirer JP. Access to specialty care. N Engl J Med 1994;331:1151–3.
Ayanian JZ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL, McNeil BJ. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med 1994;331:1136–42.
Dorrance HR, Docherty GM, O'Dwyer PJ. Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery. Dis Colon Rectum 2000;43:492–8.
Reinbach DH, McGregor JR, Murray GD, O'Dwyer PJ. Effect of the surgeon's specialty interest on the type of resection performed for colorectal cancer. Dis Colon Rectum 1994;37:1020–3.
Wigmore SJ, Madhavan K, Currie EJ, Bartolo DC, Garden OJ. Does the subspecialty of the surgeon performing primary colonic resection influence the outcome of patients with hepatic metastases referred for resection? Ann Surg 1999;230:759–66.
Zarling EJ, Piontek F, Klemka-Walden L, Inczauskis D. The effect of gastroenterology training on the efficiency and cost of care provided to patients with diverticulitis. Gastroenterology 1997;112:1859–62.
Chappuis CW, Cohn I Jr. Acute colonic diverticulitis. Surg Clin North Am 1988;68:301–13.
Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984;200:466–78.
Auguste LJ, Wise L. Surgical management of perforated diverticulitis. Am J Surg 1981;141:122–7.
Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Internal fistulas in diverticular disease. Dis Colon Rectum 1988;31:591–6.
Vasilevsky CA, Belliveau P, Trudel JL, Stein BL, Gordon PH. Fistulas complicating diverticulitis. Int J Colorectal Dis 1998;13:57–60.
Rosen L, Stasik JJ Jr, Reed JF III, Olenwine JA, Aronoff JS, Sherman D. Variations in colon and rectal surgical mortality: comparison of specialties with a state-legislated database. Dis Colon Rectum 1996;39:129–35.
Sosa JA, Bowman HM, Gordon TA,et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998;228:429–38.
Selby JV, Fireman BH, Lundstrom RJ,et al. Variation among hospitals in coronary-angiography practices and outcomes after myocardial infarction in a large health maintenance organization. N Engl J Med 1996;335:1888–96.
Porter GA, Soskolne CL, Yakimets WW, Newman SC. Surgeon-related factors and outcome in rectal cancer. Ann Surg 1998;227:157–67.
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Di Carlo, A., Andtbacka, R.H.I., Shrier, I. et al. The value of specialization—is there an outcome difference in the management of fistulas complicating diverticulitis. Dis Colon Rectum 44, 1456–1463 (2001). https://doi.org/10.1007/BF02234597