Surgeon Case Volume and Intestinal Anastomotic Leaks

摘要

After bowel resection, the restoration of its continuity involves an anastomosis operation. Any gap in the staple or suture line connecting the two portions of bowel can allow the enteric contents to leak into the peritoneal cavity, which is not equipped to manage intestinal contents and bacteria. As a result, patients with an anastomotic leak (AL) are significantly more at risk for serious postoperative complications such as bleeding, cardiovascular complications, septic shock, readmission, reoperation, and even mortality. Although ALs are not the most common postoperative GI complication, they can still pose serious, even life-threatening consequences. Limited studies have been performed analyzing the effect of individual surgeons and their experience with anastomoses on the rate of ALs. Previous studies and meta-analyses have examined surgeon volume in tiers as a risk factor for complications after different types of colorectal surgeries but were limited in that they focused on a fewer number of surgeons, only one specialty of surgery, or only one diagnosis. Because studies investigating risk factors and specifically surgeon volume have been limited in their scope and size, more research on this topic is warranted. We hypothesized that by identifying how surgeon experience can affect the outcomes of operations, we may be able to better prepare for anastomosis operations.