Effect of a colorectal bundle in an entire health care region in Switzerland: Results from a prospective cohort study (EvaCol study).

Autor:	Wiesler B; Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland., Rosenberg R; Department of Visceral Surgery, Cantonal Hospital of Basel-Land, Liestal, Switzerland., Galli R; Department of Visceral Surgery, Cantonal Hospital of Basel-Land, Liestal, Switzerland., Metzger J; Department of Visceral Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland., Worni M; Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland., Henschel M; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.; Department of Visceral Surgery, Lindenhofspital, Bern, Switzerland., Hartel M; Department of Visceral Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland., Nebiker C; Department of Visceral Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland., Viehl CT; Department of Surgery, Spitalzentrum Biel, Biel, Switzerland.; University of Basel, Basel, Switzerland., Müller A; Department of Surgery, Spitalzentrum Biel, Biel, Switzerland., Eisner L; Department of Surgery, Cantonal Hospital of Olten, Olten, Switzerland., Pabst M; Chirurgieaarau AG, Aarau, Switzerland., Zingg U; Department of Visceral Surgery, Limmattal Hospital, Zurich-Schlieren, Switzerland., Stimpfle D; Department of Visceral Surgery, Limmattal Hospital, Zurich-Schlieren, Switzerland., Müller B; Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland., von Flüe M; Chirurgie Zentrum Zentralschweiz, Lucerne, Switzerland., Peterli R; Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.; St. Clara Research Ltd., St. Clara Hospital, Basel, Switzerland., Werlen L; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland., Zuber M; Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.; St. Clara Research Ltd., St. Clara Hospital, Basel, Switzerland., Gass JM; Department of Visceral Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland., von Strauss Und Torney M; Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.; St. Clara Research Ltd., St. Clara Hospital, Basel, Switzerland.
Jazyk:	angličtina
Zdroj:	International journal of surgery (London, England) [Int J Surg] 2024 Oct 24. Date of Electronic Publication: 2024 Oct 24.
DOI:	10.1097/JS9.0000000000002123
Abstrakt:	Introduction: Standardisation has the potential to serve as a measure to mitigate complication rates. The objective was to assess the impact of standardisation by implementing a colorectal bundle (CB), which comprises nine elements, on the complication rates in left-sided colorectal resections. Patients and Methods: This prospective, multicentre, observational, cohort trial was conducted in Switzerland at nine participating hospitals. During the control period, each patient was treated in accordance with the local standard protocol at their respective hospital. In the CB period, all patients were treated in accordance with the CB. The primary endpoint was the Comprehensive Complication Index (CCI) at 30 days. Results: A total of 1141 patients were included (723 in the No CB group and 418 in the CB group). Median age was 66 years and 50.6% were female. Median CCI before and after CB implementation was 0.0 (Interquartile Range [IQR]: 0.0-20.9). A hurdle model approach was used for the analysis. The CB was not associated with the presence or severity of complications. Older age (Odds Ratio [OR] 1.02, 95% Confidence Intervall [CI]: 1.00-1.03), surgery for malignancy (OR 1.34, 95% CI: 1.01-1.92), emergency surgery (OR 2.19, 95% CI: 1.31-3.41), elevated nutritional risk score (OR 1.13, 95% CI: 1.01-1.24) and Body-Mass Index (OR 1.04, 95% CI: 1.00-1.06) were associated with higher odds of postoperative complications. In a supplementary per-protocol analysis, for each additional item of the CB fulfilled, the odds of anastomotic leakage (AL) were 24% lower (OR 0.76, 95% CI: 0.64-0.93). Conclusions: Dedicated teams can establish high quality colorectal services in a network of hospitals with a joint standard. The study can serve as a model for other healthcare settings to conduct and implement quality improvement programs. The consistent implementation of the CB items can reduce the occurrence of AL. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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