Skip to main content
SpringerLink
Log in

Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume.

Methods

The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models.

Results

Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44–0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68–0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78–0.95, p < 0.001).

Conclusions

For patients undergoing colectomy/proctectomy, in-hospital mortality decreased when the operation was performed by a CR surgeon even after accounting for hospital and surgeon volume.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. NRMP (2016) Results and Data: Specialties Matching Service, 2016 Appointment Year. Available at: www.nrmp.org/wp-content/uploads/2016/03/Results-and-Data-SMS-2016_Final.pdf; Accessed 4/10/2017 2017.

  2. Chu KM, Schoetz D. What impact might general surgery practice patterns of colon and rectal surgeons have on future training? Dis Colon Rectum 2007;50:1250–4.

  3. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–37.

    Article  PubMed  Google Scholar 

  4. Surgery ABoCaR (2016) Verify a Physician. Available at: www.abcrs.org/verify-a-phyisician-2/.

  5. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–27.

    Article  CAS  PubMed  Google Scholar 

  6. Borman KR, Vick LR, Biester TW, Mitchell ME. Changing demographics of residents choosing fellowships: longterm data from the American Board of Surgery. J Am Coll Surg 2008;206:782–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  7. Watson SL, Hollis RH, Oladeji L, Xu S, Porterfield JR, Ponce BA. The Burden of the Fellowship Interview Process on General Surgery Residents and Programs. J Surg Educ 2017;74:167–72.

    Article  PubMed  Google Scholar 

  8. Klingensmith ME, Cogbill TH, Luchette F, Biester T, Samonte K, Jones A, Lewis FR, Malangoni MA. Factors influencing the decision of surgery residency graduates to pursue general surgery practice versus fellowship. Ann Surg 2015;262:449–55; discussion 54–5.

    Article  PubMed  Google Scholar 

  9. Etzioni DA, Cannom RR, Madoff RD, Ault GT, Beart RW, Jr. Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons? Dis Colon Rectum 2010;53:713–20.

  10. Hannan EL, Radzyner M, Rubin D, Dougherty J, Brennan MF. The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 2002;131:6–15.

    Article  PubMed  Google Scholar 

  11. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 2005;242:83–91.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum 2012;55:1300–10.

  13. Shanker BA, Soliman M, Williamson P, Ferrara A. Laparoscopic Colorectal Training Gap in Colorectal and Surgical Residents. JSLS 2016;20.

  14. Stein S, Stulberg J, Champagne B. Learning laparoscopic colectomy during colorectal residency: what does it take and how are we doing? Surg Endosc 2012;26:488–92.

    Article  PubMed  Google Scholar 

  15. Hashimoto DA, Bababekov YJ, Mehtsun WT, Stapleton SM, Warshaw AL, Lillemoe KD, Chang DC, Vagefi PA Is Annual Volume Enough? The Role of Experience and Specialization on Inpatient Mortality After Hepatectomy. Ann Surg 2017.

  16. Sahni NR, Dalton M, Cutler DM, Birkmeyer JD, Chandra A. Surgeon specialization and operative mortality in United States: retrospective analysis. BMJ 2016;354:i3571.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Callahan MA, Christos PJ, Gold HT, Mushlin AI, Daly JM. Influence of surgical subspecialty training on in-hospital mortality for gastrectomy and colectomy patients. Ann Surg 2003;238:629–36; discussion 36–9.

    PubMed  PubMed Central  Google Scholar 

  18. Damle RN, Flahive JM, Davids JS, Sweeney WB, Sturrock PR, Maykel JA, Alavi K. Surgeon Volume Correlates with Reduced Mortality and Improved Quality in the Surgical Management of Diverticulitis. J Gastrointest Surg 2016;20:335–42.

    Article  PubMed  Google Scholar 

Download references

Disclaimer

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Daniel Hashimoto is financially supported by the NIH National Institute of Diabetes and Digestive and Kidney Diseases (Grant #: T32 DK007754-16A1) and by the Massachusetts General Hospital Department of Surgery Edward D. Churchill Research Fellowship. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Author notes

  1. Julia T. Saraidaridis and Daniel A. Hashimoto contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA, 01805, USA

    Julia T. Saraidaridis

  2. Department of General Surgery, Massachusetts General Hospital, Boston, USA

    Daniel A. Hashimoto, David C. Chang, Liliana G. Bordeianou & Hiroko Kunitake

Authors
  1. Julia T. Saraidaridis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel A. Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David C. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liliana G. Bordeianou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroko Kunitake
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Design/conception of work: JTS, DAH, DCC, LGB, and HK

Analysis/interpretation of data: JTS, DAH, and DCC

Drafting of manuscript: JTS, DAH, DCC, LGB, and HK

Final approval of manuscript: JTS, DAH, DCC, LGB, and HK

Agreement to be accountable: JTS, DAH, DCC, LGB, and HK

Corresponding author

Correspondence to Julia T. Saraidaridis.

Additional information

Presentation: This manuscript was presented as a podium presentation at the Annual Scientific American Society of Colon and Rectal Surgeons Tripartite Meeting, Seattle, WA, June 10–14, 2017.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saraidaridis, J.T., Hashimoto, D.A., Chang, D.C. et al. Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume. J Gastrointest Surg 22, 516–522 (2018). https://doi.org/10.1007/s11605-017-3625-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-017-3625-5

Keywords

Search

Navigation