There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
Via the hospital's electronic clinical database, we were able to identify all >45 years old patients who underwent an emergency appendicectomy. Imaging data was obtained, with histologically-confirmed appendicitis cases comprising the bulk of the study. An initial audit e encompassing the period from January 2007 to December 2016 e was undertaken in April 2019. Our findings cited two cardinal recommendations, namely: that a CT abdomen be performed in all patients over the age of 45 e with a histopathologically-confirmed appendicitis e prior to their appendicectomy, and that a colonoscopy be performed on all patients in the aforementioned group, within 1 year, post-operatively. Adherence to our proposal was audited from October 2019 e February 2020. Results: Of the 57 patients who underwent a post-operative colonoscopy e median follow-up 4 months e only 22.8% were for post-appendicectomy examination. 4 patients were found to have proximal colonic polyps, whilst 1 patient was found to have ascending colon cancer e identified 5 months post-appendicectomy. The reaudit conveyed e of the 62 patients >45 years old, who had appendicectomies e 83.3% underwent a pre-operative CT. Indeed, 63.7% had colonoscopies scheduled at 6 weeks, post-operatively, however, only 18.2% had the procedure e all of which were normal.
Conclusion:The findings from our rural DGH can help guide more apt bowel cancer care, pertaining to peri-operative imaging and endoscopic investigations. Whilst imaging recommendations were adhered to well, post-operative colonoscopies were not.
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