Understanding the relationship between surgical specialisation and outcomes following emergency surgery for colorectal cancer - a retrospective population-based study in the English NHS.

INTRODUCTION: Emergency colorectal cancer (CRC) surgery is associated with poor postoperative outcomes. In England, subspecialisation in general surgery has led to elective CRC surgery being provided by specialist CRC surgeons, while surgery for patients presenting as an emergency remains more variable. This study aimed to investigate the relationship between surgical specialisation and outcomes following emergency CRC surgery. MATERIALS AND METHODS: Population-level study of all patients in England who underwent an emergency major surgical resection for CRC (2014-2019). CRC specialist surgeons were identified using their annual workload of elective and emergency resections and membership of a CRC multidisciplinary team. Multivariable logistic regression and Cox Proportional Hazards models were used to assess the relationship between specialisation and postoperative mortality and survival. RESULTS: During the study period, 14,065 patients underwent emergency major resections. Overall, 3962 surgeons were responsible for the operations, 931 were identified as specialist CRC surgeons. Following adjustment, patients whose major surgical resection was undertaken by a non-CRC specialist surgeon were significantly more likely to die within 30- (OR 1.25 95 %CI 1.08-1.45) and 90- (OR 1.29 95 %CI 1.17-1.44) days of surgery, and less likely to survive to two-years compared to those who were operated by a CRC specialist surgeon (HR 1.12 95 %CI 1.06-1.18). CONCLUSION: Fewer than 3 in 5 patients needing an emergency operation for CRC benefit from being under the care of a CRC specialist surgeon. Better postoperative outcomes in patients presenting for emergency major bowel resection are associated with procedures that were undertaken by a CRC specialist.