SP1.6 The Impact of Subspecialty Surgeon on Outcomes After Emergency Laparotomy for Inflammatory Bowel Disease

Abstract Emergency laparotomy (Em Lap) may be required in patients with inflammatory bowel disease (IBD). NELA is the largest prospectively maintained database of adult Em Laps in England and Wales and includes clinical urgency of the cases. The impact of surgeon subspecialty on outcomes after Em lap for IBD is unclear. We have investigated this association, according to the degree of urgency in IBD Em Laps, including the effect of minimally invasive surgery (MIS). Adults with IBD in the NELA database between 2013 - 2016 were included. Surgeon subspecialty was defined as colorectal or non-colorectal. Urgencies were ‘Immediate’, ‘2-6 hours’, ‘6-18 hours’ and ’18-24 hours’. Multivariate regression was used to investigate mortality and post-operative length of stay (LOS). There was significantly reduced mortality and LOS in IBD patients who were operated on by a colorectal surgeon in the least urgent category of Em Laps; Mortality adjusted OR 2.99 (CI 1.2 – 7.8) P=0.025, LOS IRR 1.18 (CI 1.02-1.4) P=0.025. This association was not seen in more urgent categories. Colorectal surgeons were more likely to use MIS, P<0.001 and MIS was associated with decreased LOS in the least urgent cohort, P<0.001, but not in the other urgencies. We found improved outcomes in the least urgent cohort of IBD Em Laps when operated on by a colorectal surgeon in comparison to a non-colorectal general surgeon. In the most urgent cases, there was no benefit in the operation being performed by a colorectal surgeon. Further work on characterising IBD emergencies by urgency would be of value.