Clinical experience of the attending doctor matters: diagnosing anastomotic leakage after colorectal surgery

Background: Clinical assessment is vital in surgical decision-making, and clinical experience is thought to enhance diagnostic judgment. However, the impact of clinical experience on postoperative assessments in surgical care remains unclear. This is particularly critical for timely diagnosing anastomotic leakage after colorectal surgery, where delayed recognition can have severe consequences. This study evaluates to what extent the level of clinician experience influences the accuracy of clinical assessments in diagnosing anastomotic leakage. Methods: In this prospective multicenter study, clinicians daily estimated the probability (0–100) of anastomotic leakage following colorectal surgery for every patient between 2013 and 2019 in two large teaching hospitals in The Netherlands. Assessors were grouped by experience level as junior doctors and colorectal surgeons. Diagnostic accuracy per group was evaluated via Receiver Operating Characteristics (ROC) analysis, and calibration was assessed using a calibration plot. Missing data were imputed through multiple imputation. Results: 127 (9.5%) of 1336 patients developed anastomotic leakage. The area under the curve for the clinical assessment for anastomotic leakage by junior doctors was 0.87 (95% CI 0.82–0.92) as compared to 0.95 (95% CI 0.91–0.99) for colorectal surgeons (p = 0.02). Surgeons appeared to demonstrate superior calibration compared to junior doctors. Conclusion: Clinical experience enhances the accuracy of clinical assessments in diagnosing anastomotic leakage after colorectal surgery. These findings underscore the importance of involving senior clinicians in postoperative care and highlight the need for targeted training of junior doctors.