title: Use of the high dependency unit, increased consultant involvement and reduction in adverse events in patients who die after colorectal cancer surgery.
abstract: OBJECTIVE
  We prospectively audited adverse events for surgical patients with colorectal cancer who died under surgical care to test the hypothesis that increased critical care and consultant input could be associated with a reduction in adverse events.
  
  
  METHODS
  Patients with a diagnosis of colorectal cancer who died under surgical care in Scotland from 1996 to 2005 underwent peer review audit using established methodologies through the Scottish Audit of Surgical Mortality.
  
  
  RESULTS
  In the 10-year study period, 3029 patients with colorectal cancer, mean age 76 (13-105) years, died under surgical care, of whom 80% had presented as an emergency admission. Operative intervention was performed in 1557 (51%) patients of whom 1030 (34%) patients had a resection of the cancer. The annual number of patients dying after a cancer resection decreased significantly (P = 0.009). Significant decreases in adverse events were noted over time with a 67% fall in adverse events relating to critical care (P = 0.009), a 37% fall for surgical care (P = 0.04) and a significant increase in consultant anaesthetist and consultant surgeon input, but there was a 9% increase in delay as an adverse event (P = 0.006). The documented anastomotic leakage rate in patients who died increased from 8% in 1996 to 19% in 2005 (P = 0.016).
  
  
  CONCLUSIONS
  The number of patients dying with colorectal cancer after surgery has decreased in recent years. Adverse events in these patients have significantly reduced over a decade with increased consultant involvement although there is the potential for further improvement.
authors: Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee, UK. jamie.young@nhs.net
authors: J A
authors: JA
authors: Young
authors: L
authors: L
authors: Waugh
authors: G
authors: G
authors: McPhillips
authors: R J C
authors: RJ
authors: Steele
authors: A M
authors: AM
authors: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012606:Scotland; D055815:Young Adult
keywords: Colorectal cancer; High Dependency Scotland; adverse events; audit; mortality