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Reageer voor 8 maartBekijk artikel
Wat is er bereikt tijdens het 8-jarig bestaan van de Dutch ColoRectal Audit (DCRA)? Dit is te lezen in de nieuwste publicatie in het European Journal of Surgical Oncology:
Achievements in colorectal cancer care during 8 years of auditing in The Netherlands
Auteurs: de Neree tot Babberich, M. P. M., Detering, R., Dekker, J. W. T., Elferink, M. A., Tollenaar, R. A. E. M., Wouters, M. W. J. M., & Tanis, P. J.
Lees hier het volledige artikel; hieronder staat een samenvatting van het artikel.
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.
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.
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).
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.