Rate of anastomotic leak following right hemicolectomy by general surgical trainees
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ORIGINAL ARTICLE
Rate of anastomotic leak following right hemicolectomy by general surgical trainees Chu Woon Ng 1,2 & Swetha Prabhakaran 3 & Joy Chakraborty 1 & Nicholas Lutton 1 & Peter Gourlas 1 & Christopher Gillespie 1,2 & Joseph Cherng Huei Kong 1,2,3,4 Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Performing a right hemicolectomy (RH) is a core technical competency for general surgical trainees. There is a concern that anastomotic leaks occur more frequently when patients are operated on by trainees rather than by surgeons. This study aims to analyse the quality of care outcomes after RH, stratified by the experience level of the operator. Methods Patients were retrospectively recruited from the Bi-National Colorectal Cancer Audit (BCCA) Registry, from 2007 to 2018. All patients who underwent a RH for colorectal cancer were eligible. The primary outcome measure was anastomotic leak rate. Results A total of 6548 eligible right hemicolectomies were identified, with 74% being performed by consultants, 12% by fellows, and 14% by surgical trainees. The overall incidence of an anastomotic leak was 2.1%, with the highest rate of 3.7% noted among supervised registrars. Positive resection margin rate was the highest among unsupervised trainees at 10.5%, as compared with 4.3% among consultants. Anastomotic leak, anastomotic bleeding, prolonged ileus, and pneumonia occurred significantly less frequently with consultant surgeons, as compared with trainees. Independent risk factors for anastomotic leak were urgent surgery, extended right hemicolectomy, conversion to open surgery, and a lower level of operator seniority. Two independent risk factors were identified for inpatient mortality—a high ASA score (III and above) and urgent surgery. Conclusion RH is a common operative procedure in general surgical training. Data from this study may assist with the structuring of surgical training programmes, aimed at maximising both patient safety and trainee professional development and education. Keywords Right hemicolectomy . Surgical training . Trainees . Anastomotic leak
Introduction The Royal Australasian College of Surgeons (RACS) is the governing body tasked with maintaining a high standard of
Chu Woon Ng and Swetha Prabhakaran are co-first authors and have contributed equally to this study * Swetha Prabhakaran [email protected] 1
Department of Colorectal Surgery, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
2
Department of Colorectal Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland 4108, Australia
3
Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria 3004, Australia
4
Division of Cancer Surgery, The Sir Peter MacCallum Centre Department of Oncology, The University of Melbourne, Parkville, Victoria 3010, Australia
training for general surgical trainees in Australia and New Zealand [1]. The aim of the general surgical training is to ensure that trainees develop into competent surgeons,
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