Variation in perioperative practice in elective colorectal cancer surgery: opportunities for quality improvement

被引:0
作者
Taylor, John C. [1 ,2 ]
Rossington, Hannah [1 ,2 ]
George, Rina [3 ]
Alderson, Sarah L. [4 ]
Quirke, Philip [1 ]
Thomas, Caroline [5 ]
Howell, Simon [1 ]
机构
[1] Univ Leeds, Leeds Inst Med Res St Jamess, Worsley Bldg, Leeds LS2 9NL, England
[2] Univ Leeds, Leeds Inst Data Analyt, Leeds, England
[3] Doncaster & Bassetlaw Teaching Hosp NHS Fdn Trust, Doncaster, England
[4] Univ Leeds, Leeds Inst Hlth Sci, Leeds, England
[5] Leeds Teaching Hosp NHS Trust, Leeds, England
关键词
Anaesthetics; Postoperative care; ERAS; Opioids; Preassessment; Multidisciplinary team; ENHANCED RECOVERY; MANAGEMENT;
D O I
10.1007/s12672-025-02254-3
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Understanding the variation in perioperative care across a population is fundamental to improving the management and outcomes of patients with colorectal cancer. Currently, there is limited individual patient level data available to assess this variation. Therefore, as part of an improvement programme, we conducted an audit to understand perioperative care. Methods Audit items were developed to cover the pre, intra and postoperative phases of the colorectal cancer surgical pathway and collected for patients undergoing an elective procedure. The audit was conducted at 14 Hospital Trusts, participating in the Yorkshire Cancer Research Bowel Cancer Improvement Programme, located in the Yorkshire and Humber region, North of England. Results Information on 216 patients were collected. Functional assessment by Cardiopulmonary Exercise Testing varied across the region (performed in 100% patients at three Trusts, but not at all in six Trusts, P < 0.001). The provision of postoperative high dependency and critical care also varied across the region (in seven Trusts >= 80% of patients went to a monitored bed or higher level of care; in three Trusts >= 90% of patients received ward care, P < 0.001). The median duration of preoperative starvation varied by Trust (2 to 13 h, P < 0.001). The intraoperative dose of opiate administered to patients varied significantly between Trusts (P < 0.001). Conclusions There is wide variation in both the provision and practice of perioperative care across a large region in the North of England. The findings are informing a programme of improvement science-based work to improve the management and outcomes of patients with colorectal cancer.
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页数:12
相关论文
共 25 条
[1]   Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries [J].
Allemani, Claudia ;
Matsuda, Tomohiro ;
Di Carlo, Veronica ;
Harewood, Rhea ;
Matz, Melissa ;
Niksic, Maja ;
Bonaventure, Audrey ;
Valkov, Mikhail ;
Johnson, Christopher J. ;
Esteve, Jacques ;
Ogunbiyi, Olufemi J. ;
Azevedo e Silva, Gulnar ;
Chen, Wan-Qing ;
Eser, Sultan ;
Engholm, Gerda ;
Stiller, Charles A. ;
Monnereau, Alain ;
Woods, Ryan R. ;
Visser, Otto ;
Lim, Gek Hsiang ;
Aitken, Joanne ;
Weir, Hannah K. ;
Coleman, Michel P. .
LANCET, 2018, 391 (10125) :1023-1075
[2]  
[Anonymous], Pre-Operative Assessment of Fitness Score: Survey of Anesthesiology [Internet]. [cited 2018 Nov 2]
[3]   Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study [J].
Arnold, Melina ;
Rutherford, Mark J. ;
Bardot, Aude ;
Ferlay, Jacques ;
Andersson, Therese M-L ;
Myklebust, Tor Age ;
Tervonen, Hanna ;
Thursfield, Vicky ;
Ransom, David ;
Shack, Lorraine ;
Woods, Ryan R. ;
Turner, Donna ;
Leonfellner, Suzanne ;
Ryan, Susan ;
Saint-Jacques, Nathalie ;
De, Prithwish ;
McClure, Carol ;
Ramanakumar, Agnihotram V. ;
Stuart-Panko, Heather ;
Engholm, Gerda ;
Walsh, Paul M. ;
Jackson, Christopher ;
Vernon, Sally ;
Morgan, Eileen ;
Gavin, Anna ;
Morrison, David S. ;
Huws, Dyfed W. ;
Porter, Geoff ;
Butler, John ;
Bryant, Heather ;
Currow, David C. ;
Hiom, Sara ;
Parkin, D. Max ;
Sasieni, Peter ;
Lambert, Paul C. ;
Moller, Bjorn ;
Soerjomataram, Isabelle ;
Bray, Freddie .
LANCET ONCOLOGY, 2019, 20 (11) :1493-1505
[4]  
Arnold Robert, 2003, J Palliat Med, V6, P619, DOI 10.1089/109662103768253731
[5]  
Centre for Perioperative Care (CPOC), 2021, Preoperative assessment and optimisation for adult surgery
[6]   Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery [J].
Ceresoli, Marco ;
Pedrazzani, Corrado ;
Pellegrino, Luca ;
Ficari, Ferdinando ;
Braga, Marco .
EJSO, 2024, 50 (05)
[7]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[8]   Data Resource Profile: The COloRECTal cancer data repository (CORECT-R) [J].
Downing, Amy ;
Hall, Peter ;
Birch, Rebecca ;
Lemmon, Elizabeth ;
Affleck, Paul ;
Rossington, Hannah ;
Boldison, Emily ;
Ewart, Paul ;
Morris, Eva J. A. .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 2021, 50 (05) :1418-+
[9]   Perioperative acute kidney injury [J].
Goren, O. ;
Matot, I. .
BRITISH JOURNAL OF ANAESTHESIA, 2015, 115 :3-14
[10]   Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018 [J].
Gustafsson, U. O. ;
Scott, M. J. ;
Hubner, M. ;
Nygren, J. ;
Demartines, N. ;
Francis, N. ;
Rockall, T. A. ;
Young-Fadok, T. M. ;
Hill, A. G. ;
Soop, M. ;
de Boer, H. D. ;
Urman, R. D. ;
Chang, G. J. ;
Fichera, A. ;
Kessler, H. ;
Grass, F. ;
Whang, E. E. ;
Fawcett, W. J. ;
Carli, F. ;
Lobo, D. N. ;
Rollins, K. E. ;
Balfour, A. ;
Baldini, G. ;
Riedel, B. ;
Ljungqvist, O. .
WORLD JOURNAL OF SURGERY, 2019, 43 (03) :659-695