[Quality evaluation in colorectal surgery in dependence on health-care categories of hospitals - minor differences in outcome with room for improvement in process quality].
BACKGROUND
In the present study, different variables focusing on quality of colorectal surgery were investigated with respect to hospital categories: university hospital - U; hospital with maximum care responsibility (with a full spectrum of medical disciplines) - M; secondary care hospital with central regional responsibility (6-9 departments) - S; primary care hospital with local responsibility (2-5 departments) - G; The primary goal of this study was to analyse the current standard of care in patients with colorectal carcinoma in Germany.


METHODS
From 2000-2004, data of 47 435 patients with colorectal cancer were evaluated, using data compiled in the German multi-centred observational study "Colon/Rectal Carcinoma". Analysis was performed for all variables with respect to hospital categories. Due to the remarkable number of patients, differences between the groups were to be regarded as significant if p<0.01.


RESULTS
Preoperative colonoscopy (U: 70.1% M: 70.4% S: 67.9% G: 67.2) and preoperative determination of serum tumour markers (U: 83.8% M: 80.1% S: 81.9% G: 77.1) mainly indicate the quality of gastroenterological work-up before surgical intervention. In general, standards established by the "German Cancer Association" were not met and showed significantly lower rates for primary and secondary care hospitals. In contrast, variables indicating quality of perioperative course and outcome: rate of anastomotic leak (U: 2.1% M: 2.8% S: 2.1% G: 3.1%), rate of surgical intervention (U: 4.3% M: 3.1% S: 3.5% G: 3.1%) and mortality rate (U: 4.4% M: 2.2% S: 3.5% G: 4.1%) were in accordance with the requirements and did not differ significantly between all groups. However, an analysis of surgical and histopathological process quality (complete histology: U: 96.3% M: 93.6% S: 91.9% G: 90.9%) revealed significant differences with results being significantly lower for primary care hospitals.


CONCLUSIONS
There is in principle no necessity to centre colorectal surgery in tertiary care hospitals as quality parameters focusing on results and outcome are comparable. However, in primary care hospitals, there are deficits with regards to process quality. Therefore, all measures aiming to enhance in particular process quality, i. e., hospital certification or participation with quality assurance studies, are highly desirable to further improve patient care.
Scheidbach
H
H
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg. scheidbach@t-online.de
Kube
R
R
Schmidt
U
U
Robra
B-P
BP
Gastinger
I
I
Lippert
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D003107:Colorectal Surgery / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006761:Hospitals / Q000145:classification* / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D055815:Young Adult