Quality enhancement in colorectal surgery in a community hospital

Colorectal surgery still has a relatively high risk for complications. Especially anastomotic leakage is associated with high morbidity, mortality and costs. This thesis aimed to show the effect of quality improving interventions to lower complication rates after colorectal surgery and identify interventions that can be easily implemented in community hospitals with direct impact on surgical outcome.
In the first part of this thesis we show that the introduction of a relatively simple set of clinical measures reduced postoperative complications. In a second study we show that screening for frailty, and consequently postoperative medium care observation of frail patients led to a significant decrease in complication rates and was cost efficient.
The second part focuses on diagnostic instruments to detect or rule out anastomotic leakage to achieve early reinterventions and thereby reducing mortality. In our study we investigate the accuracy of CT scanning and show that rectal contrast improves the accuracy of detecting anastomotic leakage significantly. We also investigate the predictive value of C-reactive protein for anastomotic leakage and describe how it can best be used.
The third part concentrates on benign colon polyps that are too large or complex to remove during endoscopy. Our studies show that the number of patients referred for an oncological resection due to benign polyps tripled after introduction of the screening program in 2014, but complication and mortality risk after surgery are the same as for oncological patients. We show that laparoscopic wedge excision, as an alternative, could be a safe, less invasive option.