Zane Cohen Centre for Digestive Diseases, Department of Surgery, Mount Sinai Hospital, Toronto, Ont., Canada.
Can J Surg. 2010 Aug;53(4):232-40.
We sought to assess the feasibility of applying Cancer Care Ontario's quality of care indicators to a single institution's colorectal cancer (CRC) database. We also sought to assess their utility in identifying areas that require improvement.
We included patients who had surgery for CRC between 1997 and 2006 at Mount Sinai Hospital, Toronto, Ont. We excluded patients who had transanal excisions, carcinoma in situ or recurrences that required pelvic exenteration, as well as those whose information was incomplete. We obtained data from a prospective database and verified the data with hospital and office charts. We evaluated trends over a 10-year period using the Cochran-Armitage trend test.
During the study period there were 1005 surgical procedures performed in 987 patients with a mean age of 65.6 (standard deviation 15) years; the male:female ratio was 1:2. The most frequent tumour sites were the rectum and sigmoid colon (68%). Over the 10-year period, 9 indicators improved, including the proportion of patients with CRC identified by screening (p < 0.001), the proportion of patients who received preoperative liver imaging (p = 0.05), the proportion of rectal cancer patients who received preoperative pelvic imaging (p = 0.04), the proportion of patients with stage II or III rectal cancer who received radiotherapy (p = 0.03), the proportion of surgical specimens with more than 12 lymph nodes (p < 0.001), the proportion of pathology reports that included quantitative distal (p = 0.004) and radial (p < 0.001) margin measurements, the proportion of patients with an anastomotic leak (p = 0.03), the proportion of patients who received a colonoscopy 1 year after surgery (p < 0.001) and the proportion of operative reports that were complete (p < 0.001).
The use of quality of care indicators to assess the quality of colorectal surgery is feasible. This study provides benchmarks that can be used to assess changes in the quality of CRC care at our institution.
我们旨在评估将安大略省癌症护理质量指标应用于单一机构结直肠癌（CRC）数据库的可行性。我们还评估了它们在确定需要改进的领域方面的效用。
我们纳入了 1997 年至 2006 年在多伦多西奈山医院接受 CRC 手术的患者。我们排除了接受经肛门切除术、原位癌或需要盆腔切除术的复发病例以及信息不完整的患者。我们从一个前瞻性数据库中获取数据，并通过医院和办公室图表验证数据。我们使用 Cochran-Armitage 趋势检验评估了 10 年期间的趋势。
在研究期间，有 987 名患者进行了 1005 次手术，平均年龄为 65.6（标准差为 15）岁；男女比例为 1:2。最常见的肿瘤部位是直肠和乙状结肠（68%）。在 10 年期间，有 9 个指标得到改善，包括通过筛查确定的 CRC 患者比例（p<0.001）、接受术前肝脏成像的患者比例（p=0.05）、接受术前骨盆成像的直肠癌患者比例（p=0.04）、接受放疗的 II 期或 III 期直肠癌患者比例（p=0.03）、手术标本中淋巴结数超过 12 个的患者比例（p<0.001）、包括定量远端（p=0.004）和径向（p<0.001）切缘测量的病理报告比例、吻合口漏的患者比例（p=0.03）、手术后 1 年接受结肠镜检查的患者比例（p<0.001）和手术报告完整的患者比例（p<0.001）。
使用质量指标评估结直肠手术的质量是可行的。本研究提供了基准，可以用于评估我们机构 CRC 护理质量的变化。
