title: The effect of a postoperative quality improvement program on outcomes in colorectal surgery in a community hospital.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether implementation of a comprehensive quality improvement program was associated with improved outcomes in patients undergoing oncological colorectal surgery in a non-academic, non-referral community hospital.
  
  
  METHODS
  The quality improvement program (QIP) was introduced in January 2011 and consisted of the following interventions: (1) avoidance of postoperative nonsteriodal anti-inflammatory drugs; (2) normovolemia was pursued pre- and postoperatively; (3) non-resectional surgery if possible, in patients over 80 with ASA 3 or 4 classification; and (4) a standardized, postoperative surveillance protocol was introduced, with CRP determination day 2 and 4, and if necessary subsequent abdominal CT with rectal contrast to reduce delay in diagnosis of complications. From a prospectively maintained database of 488 patients undergoing colorectal surgery between 2009 and 2014, postoperative outcomes of patients operated before and after implementation of the program were compared.
  
  
  RESULTS
  The severe complication rate (Clavien-Dindo >3b) decreased significantly (25.0 vs. 13.7 %; p < .001) after implementation of the QIP program. The mortality rate dropped from 8.7 to 2.6 % (p = .003). The percentage of anastomotic leakage was 9.6% before QIP implementation and 4.2% after (p = .013). Median length of hospital stay decreased from 9 (IQR 5-19) to 7 days (IQR 4-12) (p < .001). Multivariate analyses showed that surgery after implementation of the program was a strong independent predictor for less major complications (OR 0.54, 95 % CI 0.32-0.88).
  
  
  CONCLUSIONS
  A significant decrease in major complications and mortality was observed after introduction of a relative simple quality improvement program.
authors.affiliation: Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315, RA, Almere, the Netherlands. cmarres@flevoziekenhuis.nl.
authors.forename: C C M
authors.initials: CC
authors.lastname: Marres
authors.affiliation: Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315, RA, Almere, the Netherlands.|Department of Surgery, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: A W H
authors.initials: AW
authors.lastname: van de Ven
authors.affiliation: Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315, RA, Almere, the Netherlands.
authors.forename: P C M
authors.initials: PC
authors.lastname: Verbeek
authors.affiliation: Department of Surgery, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van Dieren
authors.affiliation: Department of Surgery, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Buskens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000592:standards*; D003710:Demography; D005260:Female; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000592:standards*; D058996:Quality Improvement; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Colorectal resection; Colorectal surgery; Complications; Oncology; Quality improvement