Surgeon perceived most important factors to achieve the best hospital performance on colorectal cancer surgery: a Dutch modified Delphi method

Abstract

ObjectivesHospital variation in risk-adjusted outcomes after colorectal cancer surgery has been shown. However, explanatory factors are not sufficiently clear. The objective of this study was to identify factors perceived by gastrointestinal surgeons as important to achieve excellent casemix-adjusted outcomes after colorectal cancer surgery.DesignBased on literature and experts’ opinion, 86 factors associated with serious complications, failure to rescue and mortality were listed. These were presented to gastrointestinal surgeons through two web-based surveys and an expert meeting. Participants were asked to choose their top 10 of most important factors.ParticipantsDutch gastrointestinal surgeons (n=52) of different hospitals and different hospital types (general/teaching/academic).ResultsOf 31 invited experts for the first survey and meeting, 71% responded. Of 130 invited surgeons, 34 responded to the second survey. Factors deemed important were: procedural hospital volume (46% in top 10), specialised surgeons performing surgery, (elective 87%, emergency 60% and reoperations 62% in top 10), accessibility of, and daily ward rounds by specialised surgeons (41% and 38% in top 10), preoperative screening for malnutrition (57% in top 10), a protocol for recognition of anastomotic leakage and rapid reintervention (54% and 49% in top 10).ConclusionProcedural hospital volume, specialisation of surgeons, screening for malnutrition, early recognition of complications followed by rapid action were perceived as most important factors to achieve good outcomes by gastrointestinal surgeons.

Role of Briefing and Debriefing in Running Surgical Ward Round Effectively: A Prospective Observational Study

“…Several models and interventions have been suggested to conduct a SWR safely with maximum effectiveness [1][2][3][4][5][6][7][8]. There has been significant variations in the conduction of SWR depending upon the seniority of clinical lead (consultant versus registrar), type of patients (old patients versus new admissions) and the settings of SWR (on-call team versus non on-call team).…”

“…This diverse and complex cohort of surgical patients can pose significant diagnostic and management challenges and therefore, their adequate review during SWR can undoubtedly improve safety of the patients. Various measures to improve the effectiveness of SWR has been reported with variable success [1][2][3][4][5][6][7][8]. SWR constitute a keystone of safe hospital surgical practice and poor-quality SWR can lead to a greater number of adverse events risking the safety of the patients, thereby cascading to an increased financial strain on our already burdened healthcare system of NHS [8].…”

Funnel plots of patient‐reported outcomes to evaluate health‐care quality: Basic principles, pitfalls and considerations

“…Funnel plots clearly visualize the relation between sample size and precision: the control limits and the distribution of hospital outcomes become smaller with higher volume (ie, number of patients) 6,9 . The presentation of volume on the x ‐axis also provides the opportunity to observe an association between volume and outcome (see Figure 3), which is particularly interesting when the outcome is expected to be partly dependent on hospital‐volume, for instance, when volume is a proxy for experience with certain treatment that may lead to better outcomes 6,20 …”

“…6,9 The presentation of volume on the x-axis also provides the opportunity to observe an association between volume and outcome (see Figure 3), which is particularly interesting when the outcome is expected to be partly dependent on hospital-volume, for instance, when volume is a proxy for experience with certain treatment that may lead to better outcomes. 6,20 High and consistent response rates are also necessary to investigate volume effects: if response rates vary highly across hospitals, the sample size (ie, number of responders presented on the x-axis) is not a good representation of volume (see also Box 1 for other consequences). However, if a fixed number of patients is invited and included in the analysis (eg, 100 consecutive patients per hospital), the number of responders is equal to the response rate and thus, can be used to explore the association between response rate and outcome.…”

Determinación de los factores predictivos para complicaciones en cirugía electiva de pacientes con cáncer colorrectal. Experiencia del Instituto de Cancerología Las Américas Auna (Colombia, 2016-2019)

“…Además, después de la cirugía colorrectal, los pacientes requieren de una segunda intervención entre el 2 y el 5,8 % de las veces 7 . La morbimortalidad posoperatoria en esta población de pacientes se ha investigado en un esfuerzo por identificar factores predictivos y áreas para mejorar los resultados 8,9 , y cada vez es más claro el objetivo de los pagadores en salud en otras latitudes, de encomendar el cuidado de sus pacientes a cirujanos con los más altos volúmenes de atención y los grupos quirúrgicos con las menores cifras de complicaciones 10,11 .…”