title: Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit.
abstract: BACKGROUND
  Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques.
  
  
  METHODS
  All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993-1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144).
  
  
  RESULTS
  The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0.002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0.001). Surgical complications dropped from 37 to 11 per cent (P < 0.001). The relaparotomy rate fell from 11 to 4 per cent (P < 0.05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0.001).
  
  
  CONCLUSIONS
  The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.
authors.affiliation: Colorectal Unit, Department of Surgery, Central Hospital, Västerås, Sweden. kennet.smedh@ltvastmanland.se
authors.forename: K
authors.initials: K
authors.lastname: Smedh
authors.forename: L
authors.initials: L
authors.lastname: Olsson
authors.forename: H
authors.initials: H
authors.lastname: Johansson
authors.forename: C
authors.initials: C
authors.lastname: Aberg
authors.forename: M
authors.initials: M
authors.lastname: Andersson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002173:Cancer Care Facilities / Q000706:statistics & numerical data / Q000600:supply & distribution*; D003718:Denmark; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000706:statistics & numerical data / Q000600:supply & distribution; D006767:Hospitals, District / Q000706:statistics & numerical data / Q000600:supply & distribution; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome