Achievements in colorectal cancer care during 8 years of auditing in The Netherlands

Babberich, Michael P.M. de Neree tot; Detering, Robin; Dekker, Jan Willem T.; Elferink, M.A.G.; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.; Tanis, Pieter J.; Beets‐Tan, Regina G. H.; Bemelman, Willem A.; Boerma, Djamila; Coenen, P.P.; Dekker, Evelien; Eddes, E.H.; Gelderblom, Hans; Harst, E. van der; Karsten, T.M.; Krieken, J. Han van; Leersum, N.J. van; Lemmens, Valery; Meijerink, W.J.H.J.; Manusama, Eric R.; Marijnen, Corrie A.M.; Nagtegaal, Irıs D.; Velde, C.J. van de; Wiggers, Th.

doi:10.1016/j.ejso.2018.06.001

Cited by 53 publications

(42 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Results from Denmark showed a decrease from 7.3% in 2001–2002 to 2.8% in 2011 9. In the Netherlands, a decrease from 3.4% to 1.8% in colon cancer and from 2.3% to 1% in rectal cancer between 2009 and 2016 was reported 10…”

Section: Discussionmentioning

confidence: 95%

<p>Decentralized colorectal cancer care in Germany over the last decade is associated with high in-hospital morbidity and mortality</p>

Ghadban¹,

Reeh²,

Bockhorn³

et al. 2019

CMAR

View full text Add to dashboard Cite

PurposeDespite several national initiatives, centralization of cancer care in Germany remains insufficient for most malignancies. Currently, there is a plethora of centers, including 290 voluntary certified and audited colorectal cancer (CRC) centers by the end of 2017, in the nation with many patients still being treated outside of such centers. This study aimed to assess morbidity and mortality rates of surgical procedures for primary colorectal CRC in Germany over the last decade through a comprehensive unbiased analysis.Patients and methodsWe performed an analysis of the national diagnosis-related group inpatient statistics from 2005 to 2015 including all German hospitals. All patients who underwent surgeries for primary CRC during the study period were included.ResultsA total of 351,028 cases were analyzed (61.6% colonic and 38.4% rectal resections). The mortality rate of colonic resections remained high during the study period (4.9% in 2005 vs 4.5% in 2015; P=0.57). Reduced perioperative mortality after rectal surgery was observed only after 2012 compared to previous years (3.8% in 2005 vs 3.0% in 2015; P<0.001), with no further improvement. In-hospital morbidity such as anastomotic leak, wound infections, hemorrhage, pneumonia, deep vein thrombosis, and lung embolism did not improve for either rectal or for colonic surgery, but in contrast, most outcomes deteriorated over time.ConclusionThe present study challenges the current national health policies aiming to improve outcomes of surgical patients. CRC care in Germany remains decentralized with high in-hospital morbidity and mortality rates. New national strategies focusing on the implementation of centralization and high-quality CRC care are urgently needed.

show abstract

Section: Discussionmentioning

confidence: 95%

<p>Decentralized colorectal cancer care in Germany over the last decade is associated with high in-hospital morbidity and mortality</p>

Ghadban¹,

Reeh²,

Bockhorn³

et al. 2019

CMAR

View full text Add to dashboard Cite

show abstract

“…Several European countries, such as the UK and the Netherlands, have established protocols that centralize rectal cancer surgery. For example, over the last decade the training and centralization efforts made by the Dutch Colorectal Cancer Audit have led to a reduced 30‐day mortality rate, especially in patients with advanced tumour stages. As well as the positive impact on short‐term outcome, oncological parameters such as a negative circumferential resection margin and long‐term survival have improved within the Audit.…”

Section: Discussionmentioning

confidence: 99%

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

et al. 2020

View full text Add to dashboard Cite

Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.

show abstract

“…Because morbidity and mortality decrease with the number of surgeries performed in hospitals [ 3 , 4 ], “minimum quantities” have been recommended internationally. This has led to centralization in high volume centers [ 21 , 22 ], but without necessarily improving surgical care. Indeed, it is the management of complications that appears to be better in high-volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

Validation of MTL30 as a quality indicator for colorectal surgery

et al. 2020

View full text Add to dashboard Cite

Background Valid indicators are required to measure surgical quality. These ideally should be sensitive and selective while being easy to understand and adjust. We propose here the MTL30 quality indicator which takes into account 30-day mortality, transfer within 30 days, and a length of stay of 30 days as composite markers of an uneventful operative/postoperative course. Methods Patients documented in the StuDoQ|Colon and StuDoQ|Rectal carcinoma register of the German Society for General and Visceral Surgery (DGAV) were analyzed with regard to the effects of patient and tumor-related risk factors as well as postoperative complications on the MTL30. Results In univariate analysis, the MTL30 correlated significantly with patient and tumor-related risk factors such as ASA score (p<0.001), age (p<0.001), or UICC stage (p<0.001). There was a high sensitivity for the postoperative occurrence of complications such as re-operations (p<0.001) or subsequent bleeding (p<0.001), as well as a significant correlation with the CDC classification (p<0.001). In multivariate analysis, patient-related risk factors and postoperative complications significantly increased the odds ratio for a positive MTL30. A negative MTL30 showed a high specify for an uneventful operative and postoperative course. Conclusion The MTL30 is a valid indicator of colorectal surgical quality.

show abstract

Achievements in colorectal cancer care during 8 years of auditing in The Netherlands

Cited by 53 publications

References 31 publications

<p>Decentralized colorectal cancer care in Germany over the last decade is associated with high in-hospital morbidity and mortality</p>

<p>Decentralized colorectal cancer care in Germany over the last decade is associated with high in-hospital morbidity and mortality</p>

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

Validation of MTL30 as a quality indicator for colorectal surgery

Contact Info

Product

Resources

About