Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume

Abstract

Background: The German Cancer Society ("Deutsche Krebsgesellschaft"; DKG) certifies on a volunteer base colorectal cancer centers based on, among other things, minimum operative amounts (at least 30 oncological colon cancer resections and 20 oncological rectal cancer resections per year). In this work, nationwide hospital mortality and death after documented complications ('Failure to Rescue' ¼ FtR) were evaluated depending on the fulfillment of the minimum amounts. Methods: This is a retrospective analysis of the nationwide hospital billing data (DRG data, 2012e2017). Categorization is based on the DKG minimum quantities (fully, partially or not fulfilled). Results: Of 287,227 patients analyzed, 56.5% were operated in centers that met the DKG minimum amounts. The overall hospital mortality rate was 5.0%. In centers which met the minimum quantities, it was significantly lower (4.3%) than in hospitals which partially (5.7%) or not (6.2%) met the minimum quantities. The risk-adjusted hospital mortality rate for patients in hospitals who meet the minimum amount was 20% lower (OR 0.80; 95% CI [0.74e0.87], p < 0.001). For complications, both surgical and non-surgical, there was an unadjusted and adjusted lower FtR in hospitals that met the minimum amounts (e.g. anastomotic leak: 11.2% vs. 15.6%, p < 0.001; pulmonary artery embolism 21.3% vs. 28.2%, p ¼ 0.001). Conclusion:There is a 1/3 lower mortality and FtR rate after surgery for a colon or rectal cancer in centers fulfilling the DKG minimum amounts. The presented data implicate that there is an urgent need for a nationwide centralization program.

Indocyanine Green Near-Infrared Fluoroangiography Is a Useful Tool in Reducing the Risk of Anastomotic Leakage Following Left Colectomy

“…Anastomotic leakage requiring intervention (Grade B/C) is a severe primary complication after left-sided colorectal surgery, which leads to significant morbidity and hospital mortality of 5–7.5% in case of failure to be rescued ( 16 , 24 , 25 ). The overall rate of AL was 9.3% in German-certified clinics for colorectal cancer treatment according to a recent survey of 287,227 patients between 2012 and 2017 ( 25 ). The reported rates of AL after TME range between 3 and 21% ( 26 , 27 ).…”

Failure to rescue after reoperation for major complications of elective and emergency colorectal surgery: A population-based multicenter cohort study

“…However, in this study, FTR was defined for all operative complications, not just the ones needing reoperation, in which the FTR rate is likely higher. 33 Because of the increased risk of both mortality and morbidity, unnecessary reoperations should be avoided. The proportion of negative reoperation was 8.2%, which is lower than in previous reports.…”

Mindestmengenregelungen in der Chirurgie aus Sicht der Fachgesellschaft (DGCH)

“…In der kolorektalen Chirurgie wurde in Deutschland von der Würzburger Arbeitsgruppe um Germer eine um ein Drittel reduzierte Letalität konstatiert, wenn die Eingriffe in nach Deutscher Krebsgesellschaft zertifizierten Zentren durchgeführt werden [ 10 ]. Untersuchungen bei der transanalen Rektumchirurgie (transanale totale mesorektale Exzision, TaTME) zufolge war die Konversionsrate in High-volume-Kliniken (über 30 TaTME/Jahr) fast halbiert im Vergleich zu Nicht-High-volume-Kliniken (unter 30 TaTME/Jahr) bei zudem signifikant besserer Qualität der TME-Präparate (zirkumferenzieller Resektionsrand; [ 11 ]).…”