Comparison of perioperative outcomes of emergency hartmann resections performed by residents versus attending surgeons

Lior Orbach*, Shiran Gabay, Tal Montekio, Ariel S. Chai, Yehuda Kariv, Meir Zemel, Adam Abu-Abeid, Guy Lahat, Jonathan B. Yuval

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The optimal level of resident autonomy in emergency colorectal surgery is unclear. This study assessed perioperative outcomes in patients undergoing emergency colectomy with end stoma based on the presence of an attending surgeon. Participants: A retrospective analysis was conducted at a tertiary teaching hospital, including 360 patients who underwent emergency colectomy with end stoma between 2013 and 2023. The primary outcome was perioperative complications, including mortality. Results: Of the 360 patients, 36 (10 ​%) had surgery without an attending surgeon present. Baseline characteristics such as age (p ​= ​0.34), Charlson Comorbidity Index (p ​= ​0.313), and sex (p ​= ​0.598) were similar across groups. Perioperative outcomes showed no significant differences in major complications (Clavien-Dindo ≥3, p ​= ​0.176), 90-day complication rate (p ​= ​0.698), or 90-day mortality (p ​= ​0.389). Malignancy-related cases also did not differ in lymph node yield (p ​= ​0.685) or overall survival (log-rank p ​= ​0.574). Conclusion: In this study, Hartmann resections performed by resident teams were not associated with worse perioperative or oncologic outcomes, suggesting that resident autonomy can be safely increased without compromising patient safety.

Original languageEnglish
Article number116084
JournalAmerican Journal of Surgery
Volume240
DOIs
StatePublished - Feb 2025

Keywords

  • Acute care surgery
  • Colorectal surgery
  • Resident training
  • Surgical autonomy
  • Surgical education

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