Abstract
Introduction
The efficacy of auditing is still a subject of debate and concerns exist whether auditing
promotes risk averse behaviour of physicians. This study evaluates the achievements
made in colorectal cancer surgery since the start of a national clinical audit and
assesses potential signs of risk averse behaviour.
Methods
Data were extracted from the Dutch ColoRectal Audit (2009–2016). Trends in outcomes
were evaluated by uni and multivariable analyses. Patients were stratified according
to operative risks and changes in outcomes were expressed as absolute (ARR) and relative
risk reduction (RRR). To assess signs of risk averse behaviour, trends in stoma construction
in rectal cancer were analysed.
Results
Postoperative mortality decreased from 3.4% to 1.8% in colon cancer and from 2.3%
to 1% in rectal cancer. Surgical and non-surgical complications increased, but with
less reintervention. For colon cancer, the high-risk elderly patients had the largest
ARR for complicated postoperative course (6.4%) and mortality (5.9%). The proportion
of patients receiving a diverting stoma or end colostomy after a (L)AR decreased 11%
and 7%, respectively. In low rectal cancer, patients increasingly received a non-diverted
primary anastomosis (5.4% in 2011 and 14.4% in 2016).
Conclusions
No signs of risk averse behaviour was found since the start of the audit. Especially
the high-risk elderly patients seem to have benefitted from improvements made in colon
cancer treatment in the past 8 years. For rectal cancer, trends towards the construction
of more primary anastomoses are seen. Future quality improvement measures should focus
on reducing surgical and non-surgical complications.
Keywords
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Article info
Publication history
Published online: June 08, 2018
Accepted:
June 3,
2018
Identification
Copyright
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
