title: Complications as indicators of quality assurance after 401 consecutive colorectal cancer resections: the importance of surgeon volume in developing colorectal cancer units in India.
abstract: BACKGROUND
  The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing.
  
  
  METHODS
  We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author. In addition to patient demographics and types of resections, perioperative data like intraoperative blood loss, duration of surgery, complications, re-operation rates and hospital stay were recorded and analyzed.
  
  
  RESULTS
  The median age was 52 years (10-86 years). 279 were males and 122 were females. The average duration of surgery was 220.32 minutes (range 50-480 min). The overall complication rate was 12.2% (49/401) with a 1.2% (5/401) mortality rate. The patients having complications had an increase in their median hospital stay (from 10.5 days to 23.4 days) and the re-operation rate in them was 51%. The major complications were anastomotic leaks (2.5%) and stoma related complications (2.7%).
  
  
  CONCLUSIONS
  This largest ever series from India compares favorably with global standards. In a nation where colorectal cancer is on the rise, it is imperative that high volume centers develop specialized units to train future specialist colorectal surgeons. This would ensure improved quality assurance and delivery of health care even to outreach, low volume centers.
authors.affiliation: Department of Gastrointestinal Surgical Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Guruprasad S
authors.initials: GS
authors.lastname: Shetty
authors.forename: Yashodhan D
authors.initials: YD
authors.lastname: Bodhankar
authors.forename: Sachin
authors.initials: S
authors.lastname: Ingle
authors.forename: Rohan G
authors.initials: RG
authors.lastname: Thakkar
authors.forename: Mahesh
authors.initials: M
authors.lastname: Goel
authors.forename: Parul J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006276:Health Facility Size; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D016526:Workload; D055815:Young Adult