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Title: Risk adjusted benchmarking of clinical anastomotic leakage rate after total mesorectal excision in the context of an improvement project
Authors: Penninckx, F.
Beirens, Koen
FIEUWS, Steffen 
Ceelen, W.
Demetter, P.
Haustermans, K.
Van de Stadt, J.
Vindevoghel, K.
Issue Date: 2012
Source: COLORECTAL DISEASE, 14 (7), p. E413-E421
Abstract: 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/m2. 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.
Notes: [Penninckx, F.; Ceelen, W.; Demetter, P.; Haustermans, K.; Van de Stadt, J.; Vindevoghel, K.] PROCARE PA Fdn Belgian Canc Registry, Brussels, Belgium. [Fieuws, S.] Katholieke Univ Leuven, I Biostat, Louvain, Belgium. [Fieuws, S.] Univ Hasselt, Hasselt, Belgium.
Keywords: Colorectal surgergy; anastomotic leak; rectal cancer; benchmarking; audit;Gastroenterology & Hepatology; colorectal surgery; anastomotic leak; rectal cancer; benchmarking; audit
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ISSN: 1462-8910
e-ISSN: 1463-1318
DOI: 10.1111/j.1463-1318.2012.02977.x
ISI #: 000304994100010
Category: A1
Type: Journal Contribution
Validations: ecoom 2013
Appears in Collections:Research publications

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