Impact of surgical proficiency levels on postoperative morbidity: a single centre analysis of 558 ileostomy reversals

• Published in: International journal of colorectal disease Vol. 33; no. 5; pp. 601 - 608
• Main Authors: Löb, S., Luetkens, K., Krajinovic, K., Wiegering, A., Germer, C.-T., Seyfried, F.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2018; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Body mass index; Complications and side effects; Consultants; Consulting services; Female; Gastroenterology; Hepatology; Humans; Ileostomy; Internal Medicine; Internship and Residency; Intestine; Laparotomy; Leakage; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Original Article; Ostomy; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Postoperative Period; Proctology; Professionalism; Rankings; Surgery; Type 2 diabetes; Young Adult; Ileostomy reversal; Proficiency levels; Clavien-Dindo; Postoperative complications; Morbidity
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-018-3026-6

Purpose
Defunctioning ileostomies reduce the consequences of distal anastomotic leakage following bowel resections. Ileostomy reversal in itself, however, is associated with appreciable morbidity (3–40%) and mortality (0–4%). Despite being a common teaching procedure, there is limited information on the impact of surgical proficiency levels on postoperative outcome.
Methods
Adult patients undergoing closure of a defunctioning ileostomy between September 2008 and January 2017 were identified from a surgical administrative database that was collected prospectively (
n
 = 558). Baseline characteristics (age, ASA score, BMI, health care insurance coverage) and closure techniques were recorded. Operation time, rate of bowel resection, postoperative complications ranked by Clavien-Dindo classification and length of stay were analysed with respect to proficiency levels (residents vs. consultants).
Results
Two hundred three ileostomy reversals were performed by residents; 355 ileostomies were closed by consultants. Operation time was considerably shorter in the consultant group (
p
 < 0.001). Major postoperative complication rates however were not different among the groups when adjusted for possible confounders (
p
 = 0.948). The rate of anastomotic leakage was 3% and the overall major morbidity rate was 11%.
Conclusion
Operation time rather than surgical outcome and overall morbidity were affected by surgical proficiency levels. Therefore, ileostomy reversal can be considered an appropriate teaching operation for young general surgery trainees.