{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:26:15Z","timestamp":1780928775696,"version":"3.54.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective multicenter study, clinicians daily estimated the probability (0\u2013100) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20130.92) as compared to 0.95 (95% CI 0.91\u20130.99) for colorectal surgeons (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Surgeons appeared to demonstrate superior calibration compared to junior doctors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12729-1","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:04:19Z","timestamp":1775664259000},"page":"5243-5250","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical experience of the attending doctor matters: diagnosing anastomotic leakage after colorectal surgery"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0585-2743","authenticated-orcid":false,"given":"M.","family":"Cats","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. G.","family":"Magermans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. A. W.","family":"van Geloven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. C.","family":"van Santvoort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. C. E.","family":"Wassenaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. D. J.","family":"Plate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Boerma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"issue":"4","key":"12729_CR1","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1007\/s00261-020-02818-7","volume":"46","author":"IV Mengou","year":"2021","unstructured":"Mengou IV, Yakar D, Kasalak \u00d6, Kwee TC (2021) Towards a benchmark of abdominal CT use during duty shifts: 15-year sample from the Netherlands. Abdom Radiol 46(4):1761\u20131767. https:\/\/doi.org\/10.1007\/s00261-020-02818-7. (PMID: 33078244; PMCID: PMC8096762)","journal-title":"Abdom Radiol"},{"issue":"6","key":"12729_CR2","doi-asserted-by":"publisher","first-page":"490","DOI":"10.7861\/clinmedicine.17-6-490","volume":"17","author":"AT Elder","year":"2017","unstructured":"Elder AT, McManus IC, Patrick A, Nair K, Vaughan L, Dacre J (2017) The value of the physical examination in clinical practice: an international survey. Clin Med 17(6):490\u2013498. https:\/\/doi.org\/10.7861\/clinmedicine.17-6-490. (PMID: 29196348; PMCID: PMC6297700)","journal-title":"Clin Med"},{"issue":"10","key":"12729_CR3","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1002\/bjs.10232","volume":"103","author":"Acute Abdominal Pain (AAP) Study Group","year":"2016","unstructured":"Acute Abdominal Pain (AAP) Study Group (2016) Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain. Br J Surg 103(10):1343\u20131349. https:\/\/doi.org\/10.1002\/bjs.10232. (PMID: 27465409.)","journal-title":"Br J Surg"},{"issue":"6","key":"12729_CR4","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1007\/s11606-019-05621-3","volume":"35","author":"GJ Young","year":"2020","unstructured":"Young GJ, Flaherty S, Zepeda ED, Mortele KJ, Griffith JL (2020) Effects of physician experience, specialty training, and self-referral on inappropriate diagnostic imaging. J Gen Intern Med 35(6):1661\u20131667. https:\/\/doi.org\/10.1007\/s11606-019-05621-3. (Erratum in: J Gen Intern Med. 2020 May 6. doi: 10.1007\/s11606-020-05761-x. PMID: 31974904; PMCID: PMC7280459.)","journal-title":"J Gen Intern Med"},{"issue":"4","key":"12729_CR5","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.amjmed.2007.01.023","volume":"120","author":"CA Feddock","year":"2007","unstructured":"Feddock CA (2007) The lost art of clinical skills. Am J Med 120(4):374\u2013378. https:\/\/doi.org\/10.1016\/j.amjmed.2007.01.023. (PMID: 17398236)","journal-title":"Am J Med"},{"issue":"2","key":"12729_CR6","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.jamcollsurg.2014.11.002","volume":"220","author":"FE Turrentine","year":"2015","unstructured":"Turrentine FE, Denlinger CE, Simpson VB, Garwood RA, Guerlain S, Agrawal A et al (2015) Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg 220(2):195\u2013206. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2014.11.002. (PMID: 25592468)","journal-title":"J Am Coll Surg"},{"issue":"2","key":"12729_CR7","doi-asserted-by":"publisher","first-page":"e420","DOI":"10.1097\/SLA.0000000000003889","volume":"275","author":"TWA Koedam","year":"2022","unstructured":"Koedam TWA, Bootsma BT, Deijen CL, van de Brug T, Kazemier G, Cuesta MA, COLOR COLOR II study group et al (2022) Oncological outcomes after anastomotic leakage after surgery for colon or rectal cancer: increased risk of local recurrence. Ann Surg 275(2):e420\u2013e427. https:\/\/doi.org\/10.1097\/SLA.0000000000003889. (PMID: 32224742.)","journal-title":"Ann Surg"},{"issue":"5","key":"12729_CR8","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1097\/SLA.0b013e3182a6f2fc","volume":"259","author":"PM Krarup","year":"2014","unstructured":"Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H (2014) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 259(5):930\u2013938. https:\/\/doi.org\/10.1097\/SLA.0b013e3182a6f2fc. (PMID: 24045445)","journal-title":"Ann Surg"},{"issue":"5","key":"12729_CR9","doi-asserted-by":"publisher","first-page":"745","DOI":"10.4240\/wjgs.v15.i5.745","volume":"15","author":"V Tonini","year":"2023","unstructured":"Tonini V, Zanni M (2023) Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg 15(5):745\u2013756. https:\/\/doi.org\/10.4240\/wjgs.v15.i5.745. (PMID: 37342854; PMCID: PMC10277951)","journal-title":"World J Gastrointest Surg"},{"issue":"1","key":"12729_CR10","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1002\/bjs5.50106","volume":"3","author":"P Bostr\u00f6m","year":"2018","unstructured":"Bostr\u00f6m P, Haapam\u00e4ki MM, Ruteg\u00e5rd J, Matthiessen P, Ruteg\u00e5rd M (2018) Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer. BJS Open 3(1):106\u2013111. https:\/\/doi.org\/10.1002\/bjs5.50106. (PMID: 30734021; PMCID: PMC6354192)","journal-title":"BJS Open"},{"issue":"4","key":"12729_CR11","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00384-013-1815-5","volume":"29","author":"VN Kornmann","year":"2014","unstructured":"Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4):445\u2013451. https:\/\/doi.org\/10.1007\/s00384-013-1815-5. (PMID: 24356897)","journal-title":"Int J Colorectal Dis"},{"issue":"9","key":"12729_CR12","doi-asserted-by":"publisher","first-page":"e528","DOI":"10.1111\/codi.12379","volume":"15","author":"M den Dulk","year":"2013","unstructured":"den Dulk M, Witvliet MJ, Kortram K, Neijenhuis PA, de Hingh IH, Engel AF et al (2013) The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Colorectal Dis 15(9):e528\u2013e533. https:\/\/doi.org\/10.1111\/codi.12379. (PMID: 24199233)","journal-title":"Colorectal Dis"},{"issue":"2","key":"12729_CR13","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1007\/s00384-015-2468-3","volume":"31","author":"V Kornmann","year":"2016","unstructured":"Kornmann V, van Ramshorst B, van Dieren S, van Geloven N, Boermeester M, Boerma D (2016) Early complication detection after colorectal surgery (Condor): study protocol for a prospective clinical diagnostic study. Int J Colorectal Dis 31(2):459\u2013464. https:\/\/doi.org\/10.1007\/s00384-015-2468-3","journal-title":"Int J Colorectal Dis"},{"issue":"11","key":"12729_CR14","doi-asserted-by":"publisher","first-page":"867","DOI":"10.2471\/BLT.07.045120","volume":"85","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ 85(11):867\u2013872. https:\/\/doi.org\/10.2471\/BLT.07.045120. (PMID: 12815075.)","journal-title":"Bull World Health Organ"},{"issue":"3","key":"12729_CR15","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.surg.2009.10.012","volume":"147","author":"NN Rahbari","year":"2010","unstructured":"Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339\u2013351. https:\/\/doi.org\/10.1016\/j.surg.2009.10.012","journal-title":"Surgery"},{"issue":"18","key":"12729_CR16","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1001\/jama.2015.15281","volume":"314","author":"P Li","year":"2015","unstructured":"Li P, Stuart EA, Allison DB (2015) Multiple imputation: a primer. JAMA 314(18):1966\u20131967. https:\/\/doi.org\/10.1001\/jama.2015.15281","journal-title":"JAMA"},{"key":"12729_CR17","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jclinepi.2018.06.006","volume":"102","author":"FES Tan","year":"2018","unstructured":"Tan FES, Jolani S, Verbeek H (2018) Guidelines for multiple imputations in repeated measurements with time-dependent covariates: a case study. J Clin Epidemiol 102:107\u2013114. https:\/\/doi.org\/10.1016\/j.jclinepi.2018.06.006","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"12729_CR18","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1001\/2013.jamasurg.2","volume":"148","author":"CY Kang","year":"2013","unstructured":"Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC et al (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148(1):65\u201371. https:\/\/doi.org\/10.1001\/2013.jamasurg.2. (PMID: 22986932.)","journal-title":"JAMA Surg"},{"issue":"5","key":"12729_CR19","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1002\/bjs.9697","volume":"102","author":"FD McDermott","year":"2015","unstructured":"McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462\u2013479. https:\/\/doi.org\/10.1002\/bjs.9697","journal-title":"Br J Surg"},{"key":"12729_CR20","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1097\/00000441-200702000-00002","volume":"333","author":"LL Willett","year":"2007","unstructured":"Willett LL, Estrada CA, Castiglioni A (2007) Does residency training improve performance of physical examination skills? Am J Med Sci 333:74\u201377","journal-title":"Am J Med Sci"},{"key":"12729_CR21","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1056\/NEJMp068013","volume":"354","author":"S Jauhar","year":"2006","unstructured":"Jauhar S (2006) The demise of the physical examination. N Engl J Med 354:548\u2013551","journal-title":"N Engl J Med"},{"issue":"1","key":"12729_CR22","doi-asserted-by":"publisher","first-page":"46","DOI":"10.7196\/SAMJ.2020.v111i1.14860","volume":"111","author":"PE Fouche","year":"2020","unstructured":"Fouche PE, Jenkins LS, Vermeulen A (2020) Appropriateness of computed tomography and magnetic resonance imaging scans in a rural regional hospital in South Africa: a 6-year follow-up study. S Afr Med J 111(1):46\u201351. https:\/\/doi.org\/10.7196\/SAMJ.2020.v111i1.14860. (PMID: 33404005)","journal-title":"S Afr Med J"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12729-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-026-12729-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12729-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:53:08Z","timestamp":1780926788000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-026-12729-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["12729"],"URL":"https:\/\/doi.org\/10.1007\/s00464-026-12729-1","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]},"assertion":[{"value":"29 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"M. (Martijn) Cats, L.G (Lisa) Magermans, Dr. A.A.W. (Nanette) van Geloven, Prof. H.C. (Hjalmar) van Santvoort, E.C.E. (Emma) Wassenaar, Dr. J.D.J. (Joost) Plate, and Dr. D. (Djamila) Boerma have no conflicts of interest or financial ties to disclose. The corresponding author confirms that all authors were individually queried regarding potential conflicts of interest and completed the required disclosure forms.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The study protocol was approved by the Dutch Ethical Committee for Clinical Trials (METC) and subsequently by the research and ethical committees of both participating hospitals. The committee determined that informed consent was not required. This observational diagnostic study was not prospectively registered. A prespecified study protocol was published previously.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was not deemed necessary for this study. Large language models were used for language editing and stylistic refinement only. All analyses, interpretations, and conclusions were performed by the authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}