Risk adjusted benchmarking of clinical anastomotic leakage rate after total mesorectal excision in the context of an improvement project.

Détails

ID Serval
serval:BIB_3385D2604254
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Risk adjusted benchmarking of clinical anastomotic leakage rate after total mesorectal excision in the context of an improvement project.
Périodique
Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Auteur(s)
Penninckx F., Beirens K., Fieuws S., Ceelen W., Demetter P., Haustermans K., Van de Stadt J., Vindevoghel K., PROCARE 
Contributeur(s)
PROCARE , Bertrand C., De Coninck D., Duinslaeger M., Kartheuser A., Penninckx F., Van de Stadt J., Vaneerdeweg W., Claeys D., Burnon D., Haustermans K., Scalliet P., Spaas P., Demetter P., Jouret-Mourin A., Sempoux C., Demey W., Humblet Y., Van Cutsem E., Laurent S., Van Cutsem E., Van Laethem JL. , Op de Beeck B., Smeets P., Melange M., Rahier J., Cabooter M., Pattyn P., Peeters M., Buset M., Mansvelt B., Vindevoghel K., Van Eycken E., Dercq JP., Thijs A.
ISSN
1463-1318 (Electronic)
ISSN-L
1462-8910
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
14
Numéro
7
Pages
e413-e421
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Résumé
AIM: Anastomotic leakage (AL) after total mesorectal excision (TME) is a major adverse event. This study evaluates variability in AL between centres participating on a voluntary basis in PROCARE, a Belgian improvement project, and how further improvement of the AL rate might be achieved.
METHOD: Between January 2006 and March 2011, detailed data on 1815 patients (mean age 65.5 years, 63% male) who underwent elective TME with colo-anal reconstruction for rectal cancer were registered by 48 centres. Variability in early clinical AL rate was analysed before and after adjustment for gender, age > 60 years, American Society of Anesthesiologists score of 3 or more and body mass index > 25 kg/m(2).
RESULTS: The overall AL rate was 6.7% (95% CI 5.6%-7.9%). Early AL required reoperation in 86.8% of patients. It increased length of hospital stay from 14.7 days to 32.4 days and in-hospital mortality from 1.1% to 4.8%. Statistically significant variability in AL rate between centres was not observed, either before or after risk adjustment. Nonetheless, further improvement may be achievable in some centres by targeting the adjusted performance of better performing centres. These centres used neoadjuvant treatment, rectal irrigation, mobilization of the splenic flexure, resection of the sigmoid colon, side-to-end colo-anastomosis with or without pouch and defunctioning stoma at primary surgery in a significantly higher proportion of patients than less well performing centres.
CONCLUSION: The overall AL rate was low but needs to be interpreted with caution because of incomplete registration. Further improvement might be achieved by adopting the approach of better performing centres.
Mots-clé
Adult, Aged, Aged, 80 and over, Anastomotic Leak/epidemiology, Anastomotic Leak/prevention & control, Belgium/epidemiology, Benchmarking, Chemoradiotherapy, Adjuvant, Chi-Square Distribution, Female, Hospitals/standards, Humans, Incidence, Length of Stay, Male, Middle Aged, Neoadjuvant Therapy, Quality Improvement, Rectal Neoplasms/pathology, Rectal Neoplasms/surgery, Rectum/surgery, Reoperation, Risk Adjustment, Severity of Illness Index, Young Adult
Pubmed
Web of science
Création de la notice
20/10/2016 16:45
Dernière modification de la notice
20/08/2019 14:19
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