[Surgical therapy of rectal carcinoma. Portrayal of the current health care status within the scope of a district quality assurance study].
In an era of economic pressure, patient's participation in decision-making and evidence-based medicine, the need for quality assurance of medical processes in daily routine becomes increasingly important. The aim of this quality assessment study is to demonstrate the real state of surgical care of patients with rectal carcinoma in the context of a field study on quality management in oncology.


METHODS
Prolective cohort-study, small-area-analysis. Between 01.01.1997 and 31.12.1998, all patients with newly diagnosed rectal carcinoma and treatment in the county of Marburg-Biedenkopf (252.975 inhabitants, 3 hospitals) were included in the study. Documentation included all variables (n = 82) relevant for primary surgical therapy according to guidelines and standards.


RESULTS
146 consecutive patients fulfilled the inclusion criteria. 93% underwent resection of the tumor. In 6.6% of these cases rigid rectoscopy for determination of the tumor's distance from the anal verge was not performed. In 16.9% the colon was not examined completely. In 98.5% the state of distant metastases was documented preoperatively. 93% of the patients with tumors in the upper/middle third of the rectum and curative-intent surgery (n = 68) received a sphincter-saving operation. For all curative-intent procedures negative resection margins were confirmed histologically. Complication rates were 31.6% for anterior resection and 46.9% for abdominoperineal extirpation.


CONCLUSIONS
Comparative analysis of quality indicators revealed a predominantly good quality of care. Improving efforts can now be concentrated on few areas of suboptimal quality in the setting of internal quality management. Critical results require detailed analysis of the single cases. Thus, conditions requiring deviation from guidelines become apparent.
Kopp
I
I
Klinik für Visceral-, Thorax- und Gefässchirurgie, Philipps-Universität Marburg. kopp@mailer.uni-marburg.de
Koller
M
M
Stinner
B
B
Hainbach
S
S
Rothmund
M
M
Lorenz
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008332:Management Quality Circles; D008875:Middle Aged; D009313:National Health Programs; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D017062:Small-Area Analysis