The impact of shortened postgraduate surgical training on colorectal cancer outcome

• Published in: International journal of colorectal disease Vol. 29; no. 5; pp. 631 - 638
• Main Authors: Currie, A., Burns, E. M., Aylin, P., Darzi, A., Faiz, O. D., Ziprin, P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2014; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Colorectal cancer; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Colorectal Surgery - education; Consulting services; Education, Medical, Graduate - methods; Elective Surgical Procedures; Female; Gastroenterology; Health care reform; Hepatology; Hospital Mortality; Hospitals; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neoplasm Recurrence, Local; Original Article; Outcome Assessment (Health Care); Patient outcomes; Patient Readmission; Proctology; Registries; Reoperation; Surgery; Theater; Theater reviews; Training; United Kingdom; Work hours; Calman; Postgraduate surgical training; Colorectal cancer
• DOI: 10.1007/s00384-014-1843-9
• EISSN: 1432-1262
• ISSN: 0179-1958

Background
Shortened postgraduate surgical training reforms, known as Calman, have altered delivery of surgical training in the UK with reduced working hours and training time aiming to produce a more subspecialised workforce.
Aims
This study aims to compare rectal cancer surgical outcomes of Calman-trained consultants in a single institution to published data. Additionally, the study compared colorectal cancer surgical outcome between Calman-trained consultants (CTCs) and non-Calman consultants (NCTCs) in a national dataset.
Methods
Local dataset
Clinicopathological outcome of rectal cancer resection undertaken by CTCs in a single institution (2006–2010) were compared against NCTC counterparts.
National dataset
All elective colorectal cancer resections between 2004 and 2008 in English NHS hospitals were included. CTCs (present from 2004 onwards) were compared to NCTCs (present prior to 2004). Outcome measures included 30-day in-hospital mortality, reoperation and readmission rates.
Results
Local dataset
One hundred thirteen patients were operated under five CTC. The 30-day in-hospital mortality for CTCs (1 %) was favourable compared to published rates (3–5 %). Local recurrence rate (4.4 %) was comparable to NCTC (3.6 %).
National dataset
Between 2004 and 2008, 44,106 patients underwent elective colorectal resection. Multiple regression demonstrated CTC patients had a reduced length of stay and reduced reoperation rate. No difference in mortality and unplanned readmission rates were seen.
Conclusion
CTCs have similar safety outcome to NCTCs for colorectal cancer resection procedures. Further work is needed to assess the impact of further training reductions on clinical outcome.