The better colectomy project: association of evidence-based best-practice adherence rates to outcomes in colorectal surgery.
OBJECTIVE
To evaluate whether adherence to evidence-based best practices in colorectal surgery predicts improved postoperative outcomes.


BACKGROUND
Over a quarter of a million colon and rectal resections are performed annually in the United States. The average postoperative complication rate for these procedures approaches 30%.


METHODS
A panel of colorectal and general surgeons from 3 hospitals (1 academic medical center and 2 community hospitals) was assembled to ascertain a set of 37 evidence-based practices that they felt were the most pertinent to the evaluation and management of a patient undergoing a colorectal resection. Fifteen of these practices were classified as “key processes” for the prevention of complications. We then retrospectively reviewed medical records for 370 consecutive patients undergoing colorectal resection at these institutions. We evaluated the association of best-practice adherence to complications in the subset of patients with outcome data available through the American College of Surgeons National Surgical Quality Improvement Program.


RESULTS
Nonadherence rates exceeded 40% for 11 practices (including 2 key processes: avoidance of unnecessary blood transfusions and timely removal of central venous catheters). Among 198 patients with American College of Surgeons National Surgical Quality Improvement Program outcomes data, 38 (19%) experienced complications, of which 31 (82%) involved postoperative infection. Nonadherence to key-processes significantly predicted the occurrence of a complication (P = 0.002). Each additional process missed increased the odds of a postoperative complication by 60% (odds ratio: 1.6; 95% confidence interval: 1.2–2.2).


CONCLUSIONS
Failures of adherence with best practices in colorectal surgery is associated with an increased occurrence of complications. This study merits further research to confirm that improvement in compliance with perioperative best practices will reduce complication rates significantly.
Arriaga
Alexander F
AF
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA. aarriaga@partners.org
Lancaster
Robert T
RT
Berry
William R
WR
Regenbogen
Scott E
SE
Lipsitz
Stuart R
SR
Kaafarani
Haytham M A
HM
Elbardissi
Andrew W
AW
Desai
Priya
P
Ferzoco
Stephen J
SJ
Bleday
Ronald
R
Breen
Elizabeth
E
Kastrinakis
William V
WV
Rubin
Marc S
MS
Gawande
Atul A
AA
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D003082:Colectomy / Q000592:standards*; D020878:Device Removal / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures