Quality Measures for Colorectal Surgery

Several indicators are used to measure the quality of care after colon and rectal surgery. The Cedars-Sinai Colorectal Cancer Program at continually measures these factors to improve patient care:

  • Volume of colorectal surgical procedures. Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e., lower short-term and long-term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes.1,2 In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons.3
  • 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 expose 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.
  • Compliance with evidence-based guidelines.  Providing care according to the recommendations of the Commission on Cancer, as well as the National Quality Forum, the American Society of Oncology and the National Comprehensive Cancer Network is more likely to result in optimal patient outcomes.

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.

Data about the quality of care provided to patients receiving colorectal surgery at Cedars-Sinai is summarized in the sections below.

Comparisons of Cedars-Sinai with Other Hospitals

The California Office of Statewide Health Planning and Development collects data on the patients treated at California hospitals. Cedars-Sinai had the highest volume of both colorectal cancer surgeries and general colorectal surgeries as compared to all California hospitals in 2012, 2013 and 2014.

Number of Colon and Rectal Surgeries Performed Annually

The chart below shows the volume of colorectal cancer surgeries at Cedars-Sinai during calendar years 2012, 2013 and 2014, compared to the volumes at other hospitals in Los Angeles County.

The chart below shows the volume of all colorectal surgeries at Cedars-Sinai during calendar years 2012, 2013 and 2014, 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 expose patients to infection.

The chart below shows the average number of days patients spent at Cedars-Sinai while having colorectal cancer surgery as compared to the average number of days at other hospitals in Los Angeles County.

 

Percentage of Cancer Surgeries That Are Done Minimally Invasively vs. Open/Traditional at Cedars-Sinai  

The chart below shows the percentage of cancer surgeries performed laparoscopically for colon and rectal cancer, the percentage of cancer surgeries performed using robot assisted approaches and the percentage of cancer surgeries performed using open or traditional approaches for colon and rectal cancer at Cedars-Sinai. Robot-assisted surgery is a newer, minimally invasive procedure.

Type of Colon and Rectal Surgeries Performed Laparoscopically vs. Robot- Assisted vs. Open/Traditional at Cedars-Sinai

2013

2014

2015

Percentage of cancer surgeries performed laparoscopically (minimally invasive surgery)

84%

74%

69%

Percentage of cancer surgeries performed using robot-assisted approach

n/a*

12%

25%

Percentage of cancer surgeries done using open or traditional approaches 16% 14% 6%

 *Prior to 2014, robot-assisted procedures were not performed at Cedars-Sinai.


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, the American Society of Clinical Oncology and the National Comprehensive Cancer Network. These quality of care guidelines include:

  • Adjuvant chemotherapy is considered or administered within four 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
  • Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0 or Stage III; or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0 or Stage III; or treatment is considered; for patients under the age of 80 receiving resection for rectal cancer

For diagnosis year 2013, Cedars-Sinai performance with evidence-based guidelines for colorectal cancer care is presented below.  Data is provided by the National Cancer Database.

 For Diagnosis Year 2013

Cedars
-Sinai

California

Pacific
Region

Teaching
Hospitals

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. 

100%

85.9%

88.2%

89.4%

At least 12 regional lymph nodes are removed and pathological examined for resected colon cancer

95.9%

89.5%

90.5%

92.5%

Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is considered; for patients under the age of 80 receiving resection for rectal cancer.

100%

84.7%

87.3%

87.5%

 

1Bach PB, Ann Intern Med 2009; 150:729-30
2Greene FL, Ann Surg Oncol 2007; 15:14-15
3Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08 

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