Surgeon Perspectives on Responsibility for Acute Lower Gastrointestinal Surgical Conditions: A Modified Delphi Study

BACKGROUND: Allocation of acute lower gastrointestinal surgical conditions between acute care surgeons and colorectal surgeons remains inconsistent, with no consensus guidelines to inform service assignment in teaching hospitals where both specialties share call. STUDY DESIGN: A two-round modified Delphi study of expert surgeons was conducted with a predefined 70% consensus threshold. In round 1, participants (n=16) assigned 20 conditions to acute care surgery, colorectal surgery, or either service. Conditions without consensus were discussed in round 2 (n=13). Qualitative data were analyzed using directed content analysis. RESULTS: Consensus was achieved for 10 of 20 conditions (50%) after round 1. The remaining conditions required contextual adjudication in round 2, with no uniform specialty assignment. Qualitative analysis identified three determinants of service allocation: practice model differences, including capacity for longitudinal care; specialty-specific training, with acute care surgeons emphasizing emergency management and colorectal surgeons emphasizing pelvic, rectal, and minimally invasive expertise; and patient clinical status, wherein hemodynamic instability prioritized surgeon availability over specialty-specific expertise. CONCLUSIONS: In the absence of universal agreement, service allocation for acute lower gastrointestinal conditions depends on clinical context, surgeon expertise, and institutional resources. This Delphi-derived framework provides a structured approach to guide triage and care pathways in systems with dual acute care and colorectal surgical coverage.