Quality Measures for Colorectal Surgery
Several indicators are used to measure the quality of care after colon and rectal surgery. 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.
- 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.
- 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.
- Survival rates. The severity of the cancer and the number of years a person survives after colorectal cancer surgery are important quality of care indicators.
Data about the quality of care provided to patients receiving colorectal surgery at Cedars-Sinai Medical Center is summarized in the sections below.
Number of Colon and Rectal Procedures Performed Annually
Evidence indicates that medical centers that do more of a specific procedure tend to have better outcomes for patient. The types and numbers of colorectal surgeries done at Cedars-Sinai are summarized in the table below:
| Volume and Type of Colon and Rectal Surgeries Performed | Cedars-Sinai 2006 | Cedars-Sinai 2007 |
| Number of colon and rectal surgical procedures: | 720 | 699 |
| Number of colon and rectal cancer surgical procedures: | 200 | 185 |
| Type of surgery performed: Laparoscopic (minimally invasive) Open or traditional surgery |
62% 38% |
58% 42% |
| Percentage of colorectal surgeries that require a colostomy: | 2.5% | 1.8% |
In the chart below, the volume of colon and rectal cancer surgeries done at Cedars-Sinai Medical Center is compared to the volumes done at other Los Angeles hospitals.
| Volume of Colon or Rectal Surgeries Done at Cedars-Sinai MedicalCenter Compared to Other Los Angeles Hospitals | 2006 | 2007 |
| Cedars-Sinai Medical Center | 200 | 185 |
| UCLA | 59 | 67 |
| Los Angeles County + USC | 84 | 59 |
| Harbor-UCLA | 32 | 52 |
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 a patient to infection.
Data about the amount of time patients spent at Cedars-Sinai Medical Center while having colorectal surgery are summarized below:
| Length of Hospital Stay After Colon or Rectal Surgery | Cedars-Sinai 2006 | Cedars-Sinai 2007 |
| Average length of hospital stay after colon or rectal cancer surgery: This is the average number of days a patient stayed at Cedars-Sinai Medical Center after having colon or rectal cancer surgery. | 9.8 | 8.3 |
The table below compares the average length of stay for a patient having colon or rectal cancer at Cedars-Sinai Medical Center compared to similar patients at other Los Angeles hospitals.
| Average Length of Hospital Stays after Colon and Rectal Cancer Surgery at Cedars-Sinai Medical Center Compared to Other Los Angeles Hospitals | 2006 | 2007 |
| Cedars-Sinai Medical Center | 9.8 | 8.3 |
| UCLA | 8.3 | 7.8 |
| Los Angeles County + USC | 13.5 | 11.2 |
| Harbor-UCLA | 11.8 | 10.7 |
Colon Cancer Survival Rates
The numbers of years an individual survives with colon cancer depends on several factors:
- How early the colon cancer is diagnosed
- How quickly the tumor grows
- If the cancer has spread to other parts of the body
All of the factors above are used to identify what stage the colon cancer is at when it is found. The five stages of colon cancer are defined as follows:
- Stage 0: Cancer has been found at an early stage and is only in the inner lining of the colon.
- Stage 1: Cancer has spread from the inner lining of the colon to the second layer, the third layer and inside the colon wall. The cancer has not spread to the outer colon wall or beyond.
- Stage 2: The tumor extends through the muscular wall of the colon but has not spread to the lymph nodes.
- Stage 3: Cancer has spread outside the colon to one or more lymph nodes.
- Stage 4: Cancer has spread from the colon to other parts of the body such as the liver or lungs. The tumor can be any size and may or may not include affected lymph nodes.
Colon cancer survival rates are listed in the table below. Cedars-Sinai Medical Center compares its data to similar data from the National Cancer Database Registry. The volume of surgeries performed at Cedars-Sinai, in the table above, may not match the exact number of cancer cases in the table below. This is due to differences in data collection between Cedars-Sinai Medical Center and the National Cancer Database Registry.
| Stage: | Patients Surviving: | |||||||||
| 1 Year | 2 Years | 3 years | 4 Years | 5 years | ||||||
| CS | U.S. | CS | U.S. | CS | U.S. | CS | U.S. | CS | U.S. | |
| 0 | 95% | 95% | 89% | 91% | 89% | 88% | 84% | 84% | 75% | 81% |
| I | 93% | 93% | 85% | 89% | 76% | 85% | 65% | 80% | 65% | 75% |
| II | 95% | 91% | 92% | 82% | 85% | 75% | 78% | 68% | 72% | 82% |
| III | 96% | 88% | 80% | 76% | 67% | 66% | 65% | 58% | 59% | 52% |
| IV | 49% | 49% | 37% | 25% | 17% | 13% | 9% | 9% | 9% | 6% |
