Safety of elective colorectal cancer surgery: Non-surgical complications and colectomies are targets for quality improvement

• Published in: Journal of surgical oncology Vol. 109; no. 6; pp. 567 - 573
• Main Authors: Henneman, Daniel, ten Berge, Martijn G., Snijders, Heleen S., van Leersum, Nicoline J., Fiocco, Marta, Wiggers, Theo, Tollenaar, Rob A.E.M., Wouters, Michel W.J.M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.05.2014; Wiley Subscription Services, Inc
• Subjects: Age Distribution; Aged; Clinical Audit; Colectomy - methods; Colectomy - statistics & numerical data; colon cancer; Colonic Neoplasms - surgery; Comorbidity; Elective Surgical Procedures; failure to rescue; Female; Humans; Intensive Care Units; Laparoscopy - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Multivariate Analysis; postoperative complications; Postoperative Complications - epidemiology; postoperative mortality; Quality Improvement; Quality of Health Care; rectal cancer; Rectal Neoplasms - surgery; Retrospective Studies; Surgical Stomas - statistics & numerical data; postoperative complications; failure to rescue; postoperative mortality; colon cancer; rectal cancer
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.23532

Background Mortality following severe complications (failure‐to‐rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon‐ and rectal cancer resections. Methods Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011–2012. Severe complication‐ and FTR rates were compared between the groups in univariate and multivariate analysis. Results Colon cancer (CC) patients (n = 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n = 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06–3.37). Conclusions Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non‐)surgical complications, especially in colon cancer surgery. J. Surg. Oncol. 2014 109:567–573. © 2013 Wiley Periodicals, Inc.