Outcomes of emergency colorectal surgery within a non-colorectal split site service-a retrospective cohort study.

Abstract

Background: Emergency colorectal surgery carries a high risk of morbidity and mortality. Subspecialisation and split-site geographically distinct services may lead to critically unwell patients presenting to a non-colorectal specialist centre requiring urgent on-site intervention.

Aims: This study aims to determine outcomes of this high-risk patient cohort.

Methods: An observational retrospective study of emergency colorectal laparotomies at the Royal Infirmary of Edinburgh (RIE) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. Subgroup analysis of the vascular ischaemia cohort and colorectal surgeon involvement was performed.

Results: One hundred and eighteen patients were included. The median NELA (National Emergency Laparotomy Audit) score was 6.4% (IQR 2.5%-16.7%) and the 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 24.6%. Twenty-five patients had a vascular ischaemic pathology demonstrating a higher median NELA score (14.3%, IQR 5-22.4% vs. non-ischaemic group 5.7%, IQR 1.7-14.2%, p = 0.013) and thirty-day mortality (44%, 11/25 vs. 16.1%, 15/93, p = 0.006) than those without ischaemic pathology. Colorectal surgeon involvement in cases without ischaemia (23/93) was associated with a similar 30-day mortality (13.1% colorectal surgeon vs. 17.1% non-colorectal specialist surgeon, p = 0.755) and rate of primary anastomosis (30.4% colorectal surgeon vs. 31.8% non-colorectal specialist surgeon, p = 1).

Conclusions: The high mortality rate described highlights a specific group of unwell patients unfit for transfer. Research registration number: researchregistry7101.