title: Assessing outcomes following surgery for colorectal cancer using quality of care indicators.
abstract: BACKGROUND
  We sought to assess the feasibility of applying Cancer Care Ontario's quality of care indicators to a single institution's colorectal cancer (CRC) database. We also sought to assess their utility in identifying areas that require improvement.
  
  
  METHODS
  We included patients who had surgery for CRC between 1997 and 2006 at Mount Sinai Hospital, Toronto, Ont. We excluded patients who had transanal excisions, carcinoma in situ or recurrences that required pelvic exenteration, as well as those whose information was incomplete. We obtained data from a prospective database and verified the data with hospital and office charts. We evaluated trends over a 10-year period using the Cochran-Armitage trend test.
  
  
  RESULTS
  During the study period there were 1005 surgical procedures performed in 987 patients with a mean age of 65.6 (standard deviation 15) years; the male:female ratio was 1:2. The most frequent tumour sites were the rectum and sigmoid colon (68%). Over the 10-year period, 9 indicators improved, including the proportion of patients with CRC identified by screening (p < 0.001), the proportion of patients who received preoperative liver imaging (p = 0.05), the proportion of rectal cancer patients who received preoperative pelvic imaging (p = 0.04), the proportion of patients with stage II or III rectal cancer who received radiotherapy (p = 0.03), the proportion of surgical specimens with more than 12 lymph nodes (p < 0.001), the proportion of pathology reports that included quantitative distal (p = 0.004) and radial (p < 0.001) margin measurements, the proportion of patients with an anastomotic leak (p = 0.03), the proportion of patients who received a colonoscopy 1 year after surgery (p < 0.001) and the proportion of operative reports that were complete (p < 0.001).
  
  
  CONCLUSIONS
  The use of quality of care indicators to assess the quality of colorectal surgery is feasible. This study provides benchmarks that can be used to assess changes in the quality of CRC care at our institution.
authors.affiliation: Zane Cohen Centre for Digestive Diseases, Department of Surgery, Mount Sinai Hospital, Toronto, Ont., Canada.
authors.forename: Omar
authors.initials: O
authors.lastname: Vergara-Fernandez
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Swallow
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Brenda I
authors.initials: BI
authors.lastname: O'Connor
authors.forename: Robert
authors.initials: R
authors.lastname: Gryphe
authors.forename: Helen M
authors.initials: HM
authors.lastname: MacRae
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000592:standards*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D014057:Tomography, X-Ray Computed; D055815:Young Adult