Comparison of perioperative outcomes of emergency hartmann resections performed by residents versus attending surgeons

The optimal level of resident autonomy in emergency colorectal surgery is unclear. This study assessed perioperative outcomes in patients undergoing emergency colectomy with end stoma based on the presence of an attending surgeon. A retrospective analysis was conducted at a tertiary teaching hospital, including 360 patients who underwent emergency colectomy with end stoma between 2013 and 2023. The primary outcome was perioperative complications, including mortality. Of the 360 patients, 36 (10 ​%) had surgery without an attending surgeon present. Baseline characteristics such as age (p ​= ​0.34), Charlson Comorbidity Index (p ​= ​0.313), and sex (p ​= ​0.598) were similar across groups. Perioperative outcomes showed no significant differences in major complications (Clavien-Dindo ≥3, p ​= ​0.176), 90-day complication rate (p ​= ​0.698), or 90-day mortality (p ​= ​0.389). Malignancy-related cases also did not differ in lymph node yield (p ​= ​0.685) or overall survival (log-rank p ​= ​0.574). In this study, Hartmann resections performed by resident teams were not associated with worse perioperative or oncologic outcomes, suggesting that resident autonomy can be safely increased without compromising patient safety. •Surgical autonomy has a major role in the education of surgical residents.•Resident surgical autonomy in urgent colonic resections may be performed safely.•Complication rate was similar between resident-led and attending-led surgeries.•Oncologic cases showed equivalent results.•Higher ICU admission rate may reflect attending involvement in more complex cases.