title: Outcomes following major emergency gastric surgery: the importance of specialist surgeons.
abstract: BACKGROUND
  The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery.
  
  
  METHODS
  Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes.
  
  
  RESULTS
  Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03).
  
  
  CONCLUSIONS
  Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service.
authors.affiliation: Department of Upper Gastrointestinal and Bariatric Surgery, St George's Healthcare NHS Trust, London.
authors.forename: O A
authors.initials: OA
authors.lastname: Khan
authors.forename: E R
authors.initials: ER
authors.lastname: McGlone
authors.forename: S J
authors.initials: SJ
authors.lastname: Mercer
authors.forename: S S
authors.initials: SS
authors.lastname: Somers
authors.forename: S K C
authors.initials: SK
authors.lastname: Toh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004066:Digestive System Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D013043:Specialties, Surgical