Wiesler Benjamin, Rosenberg Robert, Galli Raffaele, Metzger Jürg, Worni Mathias, Henschel Mark, Hartel Mark, Nebiker Christian, Viehl Carsten T, Müller Alexandra, Eisner Lukas, Pabst Martina, Zingg Urs, Stimpfle Daniel, Müller Beat P, von Flüe Markus, Peterli Ralph, Werlen Laura, Zuber Markus, Gass Jörn-Markus, von Strauss Und Torney Marco
Department of Visceral Surgery, University Digestive Health Care Center, Basel, Switzerland.
Department of Visceral Surgery, Cantonal Hospital of Basel-Land, Liestal, Switzerland.
Int J Surg. 2024 Dec 1;110(12):7763-7774. doi: 10.1097/JS9.0000000000002123.
Standardization has the potential to serve as a measure to mitigate complication rates. The objective was to assess the impact of standardization by implementing a colorectal bundle (CB), which comprises nine elements, on the complication rates in left-sided colorectal resections.
This prospective, multicentre, observational, cohort trial was conducted in Switzerland at nine participating hospitals. During the control period, each patient was treated in accordance with the local standard protocol at their respective hospital. In the CB period, all patients were treated in accordance with the CB. The primary endpoint was the Comprehensive Complication Index (CCI) at 30 days.
A total of 1141 patients were included (723 in the No CB group and 418 in the CB group). The median age was 66 years, and 50.6% were female. Median CCI before and after CB implementation was 0.0 (interquartile range [IQR]: 0.0-20.9). A hurdle model approach was used for the analysis. The CB was not associated with the presence or severity of complications. Older age (odds ratio [OR] 1.02, 95% CI: 1.00-1.03), surgery for malignancy (OR 1.34, 95% CI: 1.01-1.92), emergency surgery (OR 2.19, 95% CI: 1.31-3.41), elevated nutritional risk score (OR 1.13, 95% CI: 1.01-1.24), and BMI (OR 1.04, 95% CI: 1.00-1.06) were associated with higher odds of postoperative complications. In a supplementary per-protocol analysis, for each additional item of the CB fulfilled, the odds of anastomotic leakage (AL) were 24% lower (OR 0.76, 95% CI: 0.64-0.93).
Dedicated teams can establish high-quality colorectal services in a network of hospitals with a joint standard. The study can serve as a model for other healthcare settings to conduct and implement quality improvement programs. The consistent implementation of the CB items can reduce the occurrence of AL.
标准化有可能作为一种降低并发症发生率的措施。目的是通过实施包含九个要素的结直肠捆绑式方案（CB）来评估标准化对左侧结直肠切除术并发症发生率的影响。
这项前瞻性、多中心、观察性队列试验在瑞士的九家参与医院进行。在对照期，每位患者按照各自医院的当地标准方案进行治疗。在CB期，所有患者均按照CB进行治疗。主要终点是30天时的综合并发症指数（CCI）。
共纳入1141例患者（非CB组723例，CB组418例）。中位年龄为66岁，女性占50.6%。实施CB前后的中位CCI为0.0（四分位间距[IQR]：0.0 - 20.9）。分析采用障碍模型方法。CB与并发症的存在或严重程度无关。年龄较大（优势比[OR] 1.02，95%置信区间[CI]：1.00 - 1.03）、恶性肿瘤手术（OR 1.34，95% CI：1.01 - 1.92）、急诊手术（OR 2.19，95% CI：1.31 - 3.41）、营养风险评分升高（OR 1.13，95% CI：1.01 - 1.24）和体重指数（OR 1.04，95% CI：1.00 - 1.06）与术后并发症的较高几率相关。在一项补充的符合方案分析中，CB每多满足一项，吻合口漏（AL）的几率降低24%（OR 0.76，95% CI：0.64 - 0.93）。
专业团队可以在具有联合标准的医院网络中建立高质量的结直肠服务。该研究可为其他医疗环境开展和实施质量改进项目提供一个范例。CB项目的持续实施可减少AL的发生。
