Background. Improved patient outcomes after colorectal surgery in high-volume hospitals are leading to centralization of colorectal surgery. However, it is desirable to strive for optimal quality of colorectal surgery in low-volume hospitals. This study aimed to assess the effect of the number of surgeons involved in the surgical procedure on patient outcomes in a low-volume hospital. Methods. All patients who underwent elective colorectal surgery with construction of a primary anastomosis between January 1, 2007, and December 31, 2015, were included in this retrospective cohort. The propensity score was used to adjust for confounding. Results. A total of 429 patients were included. One hundred forty-three patients (33.3%) were operated by 1 surgeon and 286 patients (66.7%) were operated by 2 surgeons. Patients operated by 2 surgeons were younger, more often male, and had a higher body mass index. A multivariate analysis with propensity scores revealed that surgery with 2 surgeons was associated with fewer reoperations (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2-0.9, P =.038). Colorectal anastomotic leakage (OR = 0.6, 95% CI = 0.2-1.3, P =.204) and mortality (OR = 0.8, 95% CI = 0.2-3.7, P =.807) were not associated with the number of surgeons involved in the surgical procedure. Conclusion. The present study shows that elective colorectal surgery in a low-volume hospital performed by 2 surgeons resulted in fewer reoperations. This might positively influence patient outcomes and might be related to increased surgical quality as compared with procedures performed by only 1 surgeon.

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Keywords colorectal surgery, evidence-based medicine, evidence-based surgery, surgical oncology
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Journal Surgical Innovation
Sparreboom, C.L, Lambrichts, D.P.V, Menon, A.G, Kleinrensink, G.J, Lingsma, H.F. (Hester F.), & Lange, J.F. (2019). Outcomes After Elective Colorectal Surgery by 2 Surgeons Versus 1 Surgeon in a Low-Volume Hospital. Surgical Innovation. doi:10.1177/1553350619868109