Impact of surgical proficiency levels on postoperative morbidity: a single centre analysis of 558 ileostomy reversals

  • S. Löb
  • K. Luetkens
  • K. Krajinovic
  • A. Wiegering
  • C.-T. Germer
  • F. Seyfried
Original Article
  • 40 Downloads

Abstract

Purpose

Defunctioning ileostomies reduce the consequences of distal anastomotic leakage following bowel resections. Ileostomy reversal in itself, however, is associated with appreciable morbidity (3–40%) and mortality (0–4%). Despite being a common teaching procedure, there is limited information on the impact of surgical proficiency levels on postoperative outcome.

Methods

Adult patients undergoing closure of a defunctioning ileostomy between September 2008 and January 2017 were identified from a surgical administrative database that was collected prospectively (n = 558). Baseline characteristics (age, ASA score, BMI, health care insurance coverage) and closure techniques were recorded. Operation time, rate of bowel resection, postoperative complications ranked by Clavien-Dindo classification and length of stay were analysed with respect to proficiency levels (residents vs. consultants).

Results

Two hundred three ileostomy reversals were performed by residents; 355 ileostomies were closed by consultants. Operation time was considerably shorter in the consultant group (p < 0.001). Major postoperative complication rates however were not different among the groups when adjusted for possible confounders (p = 0.948). The rate of anastomotic leakage was 3% and the overall major morbidity rate was 11%.

Conclusion

Operation time rather than surgical outcome and overall morbidity were affected by surgical proficiency levels. Therefore, ileostomy reversal can be considered an appropriate teaching operation for young general surgery trainees.

Keywords

Ileostomy reversal Proficiency levels Postoperative complications Morbidity Clavien-Dindo 

Notes

Acknowledgements

We would like to thank M. Hankir for proofreading of the manuscript.

Compliance with ethical standards

All procedures performed were in accordance with the standards of the institutional ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General, Visceral, Vascular and Paediatric SurgeryUniversity Hospital of WuerzburgWuerzburgGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital of WuerzburgWuerzburgGermany

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