There are several risk factors responsible for anastomotic leak after colorectal surgery, namely obesity, immunodeficiency, smoking, diabetes, cardiovascular and pulmonary diseases, advanced age... All surgeons blame patient's comorbidities when an anastomotic leak occurs.
However, there are surgeons with more cases of anastomotic leak than others. Is the patient responsible for that? Does that particular surgeon treat more difficult patients than all the others? Is the surgeon unlucky? Is the "devil" responsible for surgeon's bad luck?
One of "Top Stories" presented this month in Medscape, is about a Spanish colorectal unit study publish in "Surgery" aim to answer the following question: Is the operating surgeon responsible if the patient develops a leak?
The authors collected the data from 800 patients submitted to left-sided colorectal surgery by seven experienced surgeons. An anastomotic leak rate of 6,1% (49 patients) was reported. Individual leak rate varied from 1% to 16% among the seven surgeons. According to the Medscape "Viewpoint" those differences persisted after adjustment for other risk factors, which means that several surgeons operating a similar group of patients have different anastomotic leak rates. So... Surgeon himself makes a difference in the outcome.
Like in every job, hobby, activity, also in colorectal surgery there will always be people with more skills than others. Although intense work is always the main key to success and "the lucky one" is the most hard-working surgeon, there will always be something that makes one better than the other.
However, this is true for a very small number of surgeons. Some years ago a fellow surgeon told me that there are 3 groups of surgeons:
5% - extremely good skills (above average)
90% - average skills with good results
5% - skills bellow average
In the end, with hard work and attention to details, most of surgeons will have good results with complications rate inside an average interval. If a surgeon has a complications rate high above that interval he should stop and evaluate the factors that may be responsible for his bad results.
Do not forget: we creat most of our own luck.
Link to Medscape "Viewpoint":
Dr. Carlos Eduardo Costa Almeida
General Surgeon