Quality Measures for Colorectal Surgery
Several indicators are used to measure the quality of care after colon and rectal surgery. The Colorectal Cancer Program at Cedars-Sinai Medical Center continually measures these factors to improve patient care:
- Volume of colorectal surgical procedures. Medical centers that perform a large number of surgeries tend to have better outcomes.
- Length of stay in the hospital. Patients generally heal faster at home in a familiar environment. Fewer hospital days decrease some risks. Longer hospital stays can exposure a patient to infection.
- Number of minimally invasive (laparoscopic) procedures performed in comparison to traditional, open surgery. A smaller incision is used in laparoscopic surgery. The scar is smaller. There is less pain, a faster recovery, less chance of infection, and a quicker return to normal activities and bowel function.
If a condition is complex, the traditional (open) method of colorectal surgery might be necessary. Complex conditions include when a patient has scar tissue from a previous surgery, the bowel has holes (perforations), a tumor is blocking the bowel, or swelling of the tissues makes it difficult for the surgeon to see which areas need to be removed.
- Percentage of colorectal surgeries that result in a patient needing a colostomy. The contents of the colon are normally emptied into the rectum and are eliminated from the body. For some colon and rectal conditions, the surgeon must create an opening on the abdomen to the outside of the body (a colostomy). Then the contents of the colon empty into a bag attached to the abdomen (a colostomy bag). Having an ostomy requires special care and supplies, changes in diet, potentially more surgery, and additional medical care. A patient's body image might also be affected. Although colostomies are sometimes required, new surgical techniques decrease the need.
Data about the quality of care provided to patients receiving colorectal surgery at Cedars-Sinai Medical Center is summarized in the sections below.
Comparisons of Cedars-Sinai Medical Center with Other Hospitals
The California Office of Statewide Health Planning and Development (OSHPD) collects data on the patients treated at California hospitals. Cedars-Sinai Medical Center had the highest volume of both colorectal cancer surgeries and general colorectal surgeries as compared to all California hospitals in 2008, 2009 and 2010.
Number of Colon and Rectal Surgeries Performed Annually
Evidence indicates that medical centers that do more of a specific procedure tend to have better outcomes for patient. The chart below shows the volume of colon and rectal cancer surgeries at Cedars-Sinai Medical Center, compared to the volumes at other hospitals in Los Angeles County.
The chart below shows the volume of general colon and rectal surgeries at Cedars-Sinai Medical Center, compared to the volumes at other hospitals in Los Angeles County.
Length of Hospital Stay Following Colon or Rectal Surgery
Patients generally heal faster at home in a familiar environment. Fewer hospital days decrease some risks. Longer hospital stays can exposure patients to infection.
The chart below shows the amount of days patients spent at Cedars-Sinai Medical Center while having colorectal cancer surgery as compared to the amount of days at other hospitals in Los Angeles County.
Percentage of Cancer Surgeries That Are Done Minimally Invasively at Cedars-Sinai and Percentage of Patients Who Require a Colostomy
The chart below shows the percentage of cancer surgeries that required a colostomy and the percentage of laparoscopic colon and rectal cancer surgeries at Cedars-Sinai Medical Center.
|Type of Colon and Rectal Surgeries Performed and Percentage of Colostomies Performed at Cedars-Sinai||2009||2010||2011|
|Percentage of cancer surger performed laparoscopically (minimally invasive surgery)||62%||62%||66%|
|Percentage of cancer surgeries done using open or traditional approaches||38%||38%||34%|
|Percentage of cancer surgeries that required a colostomy||2.0%||1.7%||n/a*|
*data not available for 2011
Compliance with Evidence-Based Quality of Care Guidelines
The cancer program at Cedars-Sinai is accredited by the Commission on Cancer and participates in monitoring care associated with quality of care guidelines for colorectal cancer care endorsed by the Commission on Cancer, as well as the National quality Forum (NQF), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). These quality of care guidelines include:
- Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer
- At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer
- Radiation therapy is consider or administered within 6 months (180 days)of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer.
For diagnosis year 2009, Cedars-Sinai performance with evidence-based guidelines for colorectal cancer care is present below. Data is provided by the National Cancer Database (NCDB).
For Diagnosis Year 2009
Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer.
At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer
Radiation therapy is consider or administered within 6 months (180 days)of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer.