Effect of a colorectal bundle in an entire health care region in Switzerland: Results from a prospective cohort study (EvaCol study).

IF 12.5 2区 医学 Q1 SURGERY International journal of surgery Pub Date : 2024-10-24 DOI:10.1097/JS9.0000000000002123
B Wiesler, R Rosenberg, R Galli, J Metzger, M Worni, M Henschel, M Hartel, C Nebiker, C T Viehl, A Müller, L Eisner, M Pabst, U Zingg, D Stimpfle, B Müller, M von Flüe, R Peterli, L Werlen, M Zuber, J-M Gass, M von Strauss Und Torney
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Abstract

Introduction: Standardisation has the potential to serve as a measure to mitigate complication rates. The objective was to assess the impact of standardisation by implementing a colorectal bundle (CB), which comprises nine elements, on the complication rates in left-sided colorectal resections.

Patients and methods: 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.

Results: A total of 1141 patients were included (723 in the No CB group and 418 in the CB group). 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% Confidence Intervall [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 Body-Mass Index (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).

Conclusions: 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.

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结直肠捆绑疗法在瑞士整个医疗保健地区的效果:一项前瞻性队列研究(EvaCol 研究)的结果。
导言:标准化是降低并发症发生率的潜在措施。该研究旨在评估通过实施由九个要素组成的结直肠束(CB)实现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,每位患者都按照各自医院的当地标准方案接受治疗。在CB期间,所有患者都按照CB进行治疗。主要终点是 30 天后的综合并发症指数(CCI):共纳入 1141 名患者(无 CB 组 723 人,CB 组 418 人)。中位年龄为 66 岁,50.6% 为女性。实施 CB 前后的 CCI 中位数均为 0.0(四分位距 [IQR]:0.0-20.9)。分析采用了阶跃模型法。CB 与并发症的出现或严重程度无关。年龄较大(Odds Ratio [OR] 1.02,95% Confidence Intervall [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)与术后并发症发生几率较高有关。在一项补充性协议分析中,每多达一项CB指标,吻合口漏(AL)的几率就会降低24%(OR 0.76,95% CI:0.64-0.93):专职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。该研究可作为其他医疗机构开展和实施质量改进计划的典范。持续实施 CB 项目可减少 AL 的发生。
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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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