Better outcomes when emergency surgery performed by busier surgeons, study finds

Outcomes for many patients requiring emergency surgery are better when the operation is done by busier surgeons, new Irish research indicates.

Patients who undergo the most common form of emergency surgery, to the abdomen, are more likely to survive when operated on by a surgeon performing high volumes of work, the study shows.

Conversely, low volume surgical teams have consistently higher mortality for emergency abdominal surgery than high volume teams, the analysis of five years of hospital records shows.

Royal College of Surgeons of Ireland (RCSI) president and study co-author Ken Mealy said the finding has "huge implications" that need to be considered by the HSE, hospital groups and at political level. He says it bolsters the case for reducing the number of hospitals providing critical surgery services.

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“For many years now, we have argued that reconfiguring surgical services in Ireland with surgeries carried out in the most appropriate setting would improve patient outcomes. Following this study, the question which must now be considered is whether or not low-volume surgeons or low-volume hospitals should continue to provide on-call acute surgical services,” Mr Mealy said.

Volume of work

Currently, 26 hospitals provide surgical services in Ireland, though in many smaller hospitals the volume of work is low by international standards.

Mr Mealy said that Finland, with a similar population, has eight to 10 centres, while if Ireland were to follow UK arrangements, it would offer surgery in only 10 locations.

The study, published in BMJ Open, analysed more than 10,000 emergency abdominal surgeries carried out between 2014 and 2018 in 24 public hospitals. Almost 800 patients died in hospital.

The mortality rate for low-volume surgical teams was 85.4 deaths per 1,000 patients, well above the 54.7 deaths per 1,000 patients recorded for high-volume teams. High-volume surgical teams perform more than 12 procedures a year, while low-volume teams performed fewer than six.

“Our objective in undertaking this study is to help inform a critical and ongoing conversation about the future structure of emergency surgical services in Ireland. I urge all of the parties involved to address these issues as a matter of urgency so that patients can be provided with the answers they will seek and so that outcomes can improve,” Mr Mealy said.