van Groningen Julia Tessa, Marang-van de Mheen Perla J, Henneman Daniel, Beets Geerard L, Wouters Michel W J M
Department of Surgery, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
BMJ Open. 2019 Sep 24;9(9):e025304. doi: 10.1136/bmjopen-2018-025304.
Hospital variation in risk-adjusted outcomes after colorectal cancer surgery has been shown. However, explanatory factors are not sufficiently clear. The objective of this study was to identify factors perceived by gastrointestinal surgeons as important to achieve excellent casemix-adjusted outcomes after colorectal cancer surgery.
Based on literature and experts' opinion, 86 factors associated with serious complications, failure to rescue and mortality were listed. These were presented to gastrointestinal surgeons through two web-based surveys and an expert meeting. Participants were asked to choose their top 10 of most important factors.
Dutch gastrointestinal surgeons (n=52) of different hospitals and different hospital types (general/teaching/academic).
Of 31 invited experts for the first survey and meeting, 71% responded. Of 130 invited surgeons, 34 responded to the second survey. Factors deemed important were: procedural hospital volume (46% in top 10), specialised surgeons performing surgery, (elective 87%, emergency 60% and reoperations 62% in top 10), accessibility of, and daily ward rounds by specialised surgeons (41% and 38% in top 10), preoperative screening for malnutrition (57% in top 10), a protocol for recognition of anastomotic leakage and rapid reintervention (54% and 49% in top 10).
Procedural hospital volume, specialisation of surgeons, screening for malnutrition, early recognition of complications followed by rapid action were perceived as most important factors to achieve good outcomes by gastrointestinal surgeons.
已表明结直肠癌手术后风险调整结局存在医院差异。然而，解释性因素尚不够明确。本研究的目的是确定胃肠外科医生认为对结直肠癌手术后实现出色的病例组合调整结局至关重要的因素。
基于文献和专家意见，列出了86个与严重并发症、未能挽救及死亡率相关的因素。通过两项基于网络的调查和一次专家会议将这些因素呈现给胃肠外科医生。要求参与者选出最重要的10个因素。
来自不同医院及不同医院类型（综合/教学/学术）的荷兰胃肠外科医生（n = 52）。
在首次调查和会议邀请的31位专家中，71%做出了回应。在130位受邀外科医生中，34位对第二次调查做出了回应。被认为重要的因素包括：手术医院量（在前十中占46%）、进行手术的专科医生（择期手术在前十中占87%，急诊手术占60%，再次手术占62%）、专科医生的可及性及每日查房（在前十中分别占41%和38%）、术前营养不良筛查（在前十中占57%）、吻合口漏识别及快速再次干预方案（在前十中分别占54%和49%）。
手术医院量、外科医生专业化、营养不良筛查、并发症的早期识别及随后的快速行动被胃肠外科医生视为实现良好结局的最重要因素。
