Wednesday, August 17, 2011

Patients who undergo bowel surgery face a postcode lottery of care, research suggests.

In some parts of the country, those who are operated on at much higher risk of needing further treatment to stop bleeding or correct complications.
Academics found a fivefold difference in reoperation rates in NHS hospitals for planned bowel surgery.
It comes after a landmark study showed that bowel cancer sufferers in some parts of the country after almost 10 times as likely to die after surgery for the disease.
Researchers at Imperial College London conclude, in a paper published online at, that figures for the number of repeat operations could be used to compare quality alongside death rates for a range of types of surgery.
They write: “This study supports the feasibility of using reoperation rate as a quality indicator derived from routinely collected data.
“If data accuracy can be assured, this methodology may permit national performance assessment using reoperation alongside other indicators such as mortality and will be easily transferable across a range of surgical specialties.
“Initiatives to improve surgical performance should be focused on reducing inexplicable observed variation in reoperation after major resectional colorectal surgery.”
The team used Hospital Episode Statistics to look at the experiences of 246,469 patients in 175 English hospitals who underwent colorectal surgery between 2000 and 2008.
They found that in total, 15,986 needed further surgery (6.5 per cent of the total) within 28 days of the original operation, mainly to stop “postoperative bleeding” or a breakage that leads to the leak of gastric or intestinal fluid.
Emergency patients and men were slightly more likely to need extra procedures, as were those who had inflammatory bowel disease.
But the researchers also found “considerable variation” between individual surgeons and NHS trusts in their reoperation rates.
Some hospitals reported no reoperations but others had rates of 17 per cent.
The reoperation rate was five times as high for planned surgery in the highest-performing hospitals compared with the lowest (14.9 per cent compared with 2.8 per cent), among those that performed more than 500 procedures.
In a comment piece, Arden Morris, Associate Professor of Surgery at the University of Michigan, says that measuring quality is only the first step in the more important goal of improving quality.
She warns that forcing hospitals to publish their reoperation rates will not necessarily help, and that proposals to improve patient care are also needed.
“Policy interventions that do not deal with underlying mechanisms are not likely to improve outcomes. Instead, they may perversely contribute to tension between quality measurement and quality improvement.
“For example, a call for mandatory reporting of reoperation rates is unlikely to result in a change in surgical technique but could increase rote paperwork and even cynicism among providers.”

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