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Use of the high dependency unit, increased consultant involvement and reduction in adverse events in patients who die after colorectal cancer surgery
Author(s) -
Young J. A.,
Waugh L.,
McPhillips G.,
Steele R. J. C.,
Thompson A. M.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12161
Subject(s) - medicine , adverse effect , colorectal cancer , audit , cancer , emergency medicine , surgery , general surgery , management , economics
Aim We prospectively audited adverse events for surgical patients with colorectal cancer who died under surgical care to test the hypothesis that increased critical care and consultant input could be associated with a reduction in adverse events. Method Patients with a diagnosis of colorectal cancer who died under surgical care in S cotland from 1996 to 2005 underwent peer review audit using established methodologies through the S cottish A udit of S urgical M ortality. Results In the 10‐year study period, 3029 patients with colorectal cancer, mean age 76 (13–105) years, died under surgical care, of whom 80% had presented as an emergency admission. Operative intervention was performed in 1557 (51%) patients of whom 1030 (34%) patients had a resection of the cancer. The annual number of patients dying after a cancer resection decreased significantly ( P = 0.009). Significant decreases in adverse events were noted over time with a 67% fall in adverse events relating to critical care ( P = 0.009), a 37% fall for surgical care ( P = 0.04) and a significant increase in consultant anaesthetist and consultant surgeon input, but there was a 9% increase in delay as an adverse event ( P = 0.006). The documented anastomotic leakage rate in patients who died increased from 8% in 1996 to 19% in 2005 ( P = 0.016). Conclusion The number of patients dying with colorectal cancer after surgery has decreased in recent years. Adverse events in these patients have significantly reduced over a decade with increased consultant involvement although there is the potential for further improvement.