Current practice in obtaining colleague input on challenging emergency general surgery cases: A survey of surgeons in a regional acute care surgery network.

Abstract

Recent studies have suggested that surgeon years of experience are associated with postoperative outcomes for emergency general surgery (EGS) patients and that there may be a benefit to obtaining input from colleagues in high-risk EGS cases. We aimed to assess current EGS practices regarding obtaining a second opinion for emergency cases and barriers to doing so across an acute care surgery network. Surgeons providing EGS coverage across a cohort of hospitals comprising an acute care surgery network were queried in this original research survey study. Survey questions targeted surgeon perception of factors related to increased mortality and current practice regarding barriers to obtaining input from a colleague. Forty-eight surgeons responded to the survey (80%). Surgeons perceived patient age 70 years or older and American Society of Anesthesiologists score ≥3 to be the highest risk factors for mortality. Surgeons reported that, in 23% of cases, they obtained input from a colleague most commonly because of case complexity. About a third of the time input impacted the decision to operate or operative approach. The most significant barrier to obtaining input from a colleague was the time of day/night. Obtaining input from a surgical colleague is not uncommon in current practice and often impacts the care plan. The most significant barrier to obtaining colleague input may potentially be overcome by creating a cohort of trusted surgeons within a health system who are available for consultation at all times of day and night. Future studies to elucidate how to identify trusted surgeons and the impact of such a structure on patient outcomes are needed. Therapeutic/Care Management; Level IV.