Surgeon perceived most important factors to achieve the best hospital performance on colorectal cancer surgery

A Dutch modified Delphi method

Journal article (2019)

Authors

Julia T. Van Groningen Leiden University Medical Center, Dutch Institute for Clinical Auditing
P.J. Marang-van de Mheen Leiden University Medical Center
D. Henneman Leiden University Medical Center
Geerard L. Beets Netherlands Cancer Institute
M. W.J.M. Wouters Netherlands Cancer Institute, Dutch Institute for Clinical Auditing
Affiliation
External organisation
Clinical audit Colorectal surgery Gastrointestinal tumours Quality In health care
More Info
expand_more

Published Date

2019

Language

English

Reuse Rights

Other than for strictly personal use, it is not permitted to download, forward or distribute the text or part of it, without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license such as Creative Commons.

Affiliation

External organisation

Abstract

Objectives 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. Design 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. Participants Dutch gastrointestinal surgeons (n=52) of different hospitals and different hospital types (general/teaching/academic). Results 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). Conclusion 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.