Postoperative deaths fall, says bowel cancer audit - emergency admissions still cause for concern

17 December 2012

Health and Social Care Information Centre press release: Postoperative deaths fall for fourth consecutive year - call to “break taboo that locks symptoms behind bathroom door” as emergency admissions continue to cause concern

The proportion of bowel cancer patients who die following major surgery has fallen for the fourth consecutive year, new figures from the National Bowel Cancer Audit show. 5.1 per cent of patients diagnosed in 2010-11 (the current audit year), had died 90 days on from their operation, compared to 6.4 per cent of patients diagnosed in 2007-08.

The audit shows that keyhole (laparoscopic) surgery rates rose in the same time period from 25 per cent to over 40 per cent. Keyhole surgery was found to be associated with both shorter hospital stay (six days, compared to nine days for open surgery patients) and a reduced risk of post-operative death (2.6 per cent for keyhole surgery versus 6.7 per cent for open surgery). However keyhole surgery is usually performed on fitter patients, with less advanced disease, who come into hospital for a planned operation.

Today's audit report, which looked at data for just over 29,000 bowel cancer patients diagnosed in 2010-11, was commissioned by the Healthcare Quality Improvement Partnership and developed by the Health and Social Care Information Centre, the Association of Coloproctology of Great Britain and Ireland and the Royal College of Surgeons of England.

It also highlights that emergency admissions for bowel cancer continue to be a major cause of concern. Overall, 21.1 per cent of patients with bowel cancer were admitted as an emergency with severe and potentially life-threatening symptoms. Nearly one third of these admissions were not suitable for surgical intervention (29.5 per cent) and of those that had emergency surgery, more than one in 10 had died within 90 days of the emergency operation (11.9 per cent).
Through new data analysis, the audit today also highlights a delay in the closure of "temporary" stomas after operations to remove rectal (back-passage) cancer. Patients are commonly counselled that a "temporary" stoma after rectal cancer surgery (anterior resection) will be closed within six months of surgery. However today's new analysis (which links audit data to Hospital Episode Statistics (HES information) shows 38 per cent of patients still had a "temporary" stoma 12 months after undergoing an anterior resection. Future work is required to determine if this delay is related to further treatments, such as postoperative chemotherapy, or a lack of operating time.

Nigel Scott, audit clinical lead and consultant colorectal surgeon at the Royal Preston Hospital, said: "The National Bowel Cancer Audit continues to make a contribution to understanding and improving the patient journey with bowel cancer. However, bowel cancer emergency admissions are a persistent and very significant health problem. Symptom awareness campaigns are useful to break down the taboos of bottoms and bowels that lock these symptoms behind the bathroom door. But emergency surgery continues to be the Cinderella of surgical practice in the UK.

A recent survey of surgeons highlighted that the NHS pressures currently work against emergency cases with 55 per cent of surgeons describing inadequate emergency theatre access. Only 15 per cent of emergency surgeons have a comprehensive interventional radiology service out of hours and this deficiency has a major detrimental effect on the use of colonic stenting for the emergency colorectal cancer admission. These findings are also mirrored in a recently published report by the Department of Health and the Royal College of Surgeons."

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