title: With adequate supervision, the grade of the operating surgeon is not a determinant of outcome for patients undergoing urgent colorectal surgery.
abstract: BACKGROUND
  It is essential that higher surgical trainees (HSTs) obtain adequate emergency operative experience without compromising patient outcome. The aim of this study was to compare the outcomes of patients operated by HSTs with those operated by consultants and to look at the effect of consultant supervision.
  
  
  METHODS
  A retrospective analysis of 362 patients who underwent urgent colorectal surgery was performed. The primary outcome was 30-day mortality. Secondary outcomes were intra-operative and postoperative surgery, specific and systemic complications, and delayed complications.
  
  
  RESULTS
  Comparison of the patients operated by a consultant (n = 190) and a HST (n = 172) as the primary surgeon revealed no significant difference between the two groups for age, gender, ASA status or indication for surgery. There was a difference in the type of procedure performed (left-sided resections: consultants 122/190, HST 91/172; P = 0.050). There was no difference between the two groups for the primary and secondary outcomes. However, HSTs operating unsupervised performed significantly fewer primary anastomoses for left-sided resections (P = 0.019) and had more surgery specific complications (P = 0.028) than those supervised by a consultant.
  
  
  CONCLUSIONS
  HSTs can perform emergency colorectal surgery with similar outcomes to their consultants, but adequate consultant supervision is vital to achieving these results.
authors.affiliation: Department of Surgery, Russells Hall Hospital, Dudley, West Midlands, UK. willhawkins@blueyonder.co.uk
authors.forename: W J
authors.initials: WJ
authors.lastname: Hawkins
authors.forename: K M
authors.initials: KM
authors.lastname: Moorthy
authors.forename: D
authors.initials: D
authors.lastname: Tighe
authors.forename: K
authors.initials: K
authors.lastname: Yoong
authors.forename: R T
authors.initials: RT
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000401:mortality / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome