Table 2.
Percentage of respondents reporting a factor in their top 10, sum of points assigned and mean rank within category
| Factors leading to good outcomes in colorectal cancer surgery | Percentage in top 10 n=34, % |
Assigned points (minimum–maximum) n=31 | Mean rank (SD) n=27–24 |
| Preoperative | n=27 | ||
| Preoperative screening of patients for malnutrition, followed by dietary measures* | 57 | 150 (2–20) | 3.07 (SD 1.639) |
| Preoperative screening of elderly by a geriatrician | 35 | 61 (3–10) | 4.7 (SD 2.072) |
| Preoperative visit of the patient to an anaesthesiologists | 32 | 63 (3–15) | 4.33 (SD 2.572) |
| Preoperative opportunity to discuss a complex patient in a preoperative discussion with an intensivist or anaesthesiologist | 29 | 93 (5–20) | 4.59 (SD 3.067) |
| Preoperative counselling patients to quit smoking | 19 | 55 (5–20) | 5.19 (SD 2.760) |
| Preoperative pulmonary training | 19 | 53 (0–20) | 4.37 (SD 1.757) |
| The surgeon visits the patient the day before the surgery, or has seen the patient at the preoperative consultation | 8 | 20 (10–10) | 5.63 (SD 2.871) |
| Preoperative visit of patients to a multidisciplinary outpatient clinic | 3 | 7 (7–7) | 6.52 (SD 2.190) |
| The anaesthesiologist that performs the anaesthesia visits the patient the day before the surgery, or sees the patient at the preoperative consultation | 3 | 0 | 6.59 (SD 2.258) |
| Intraoperative, elective | n=26 | ||
| Elective surgery is performed by surgeons with a specialisation in gastrointestinal oncology* | 87 | 358 (5–50) | 1.42 (SD 0.987) |
| A hypovolemic situation during the surgery is actively avoided | 32 | 90 (5–20) | 3.73 (SD 1.756) |
| The ratio between laparoscopy and laparotomy in an elective setting | 16 | 37 (2–20) | 4.69 (SD 2.035) |
| The percentage of patients with elective surgery that receive a definite ostomy | 14 | 35 (5–15) | 4.04 (SD 1.708) |
| The percentage of patients with elective surgery that receive a diverting ostomy in addition to the anastomosis | 8 | 25 (5–20) | 3.77 (SD 1.751) |
| The percentage of patients with laparoscopic surgery that has to be converted to laparotomy | 5 | 0 | 4.85 (SD 1.515) |
| The percentage of patients that receive epidural anaesthetics | 5 | 0 | 5.5 (SD 1.421) |
| Intraoperative, emergency/urgent | n=26 | ||
| Emergency or urgent surgery is performed by surgeons with specialisation in gastrointestinal oncology* | 60 | 235 (5–20) | 1.31 (SD 0.549) |
| The percentage of patient that receive an anastomosis in emergency or urgent surgery | 22 | 65 (5–20) | 1.88 (SD 0.516) |
| De ratio between laparoscopy and laparotomy surgery in emergency or urgent setting | 5 | 10 (5–5) | 2.81 (SD 0.567) |
| Postoperative | n=24 | ||
| Presence of a protocol for early recognition of anastomotic leakage* | 54 | 175 (5–20) | 2.96 (SD 1.628) |
| Accessibility of a surgeon specialised in gastrointestinal oncology to also review a patient, during business hours (beyond ward rounds)* | 41 | 108 (5–15) | 2.79 (SD 1.062) |
| Daily ward rounds by the surgeon that performed the surgery or another surgeon specialised in gastrointestinal oncology* | 38 | 123 (5–20) | 2.08 (SD 1.472) |
| Patients are postoperative admitted on a ward specialised on gastrointestinal and oncological surgery | 32 | 90 (5–20) | 3.71 (SD 1.517) |
| Presence of a protocol for testing CRP and consequences according to outcomes | 22 | 80 (5–20) | 4.21 (SD 1.414) |
| Presence of a case manager who contacts the patient after hospitalisation | 3 | 0 | 5.25 (SD 1.152) |
| Complications/reinterventions | n=24 | ||
| Reoperation is performed by surgeons with a specialisation in gastrointestinal oncology* | 62 | 185 (2–20) | 1.71 (SD 0.999) |
| Time elapsed between first symptoms of a complication and a re-intervention* | 49 | 210 (5–25) | 1.62 (SD 0.576) |
| No of reinterventions per patient with a serious complication | 5 | 10 (10–10) | 3.08 (SD 0.776) |
| The ratio between radiological and surgical reintervention | 3 | 10 (10–10) | 3.58 (SD 0.504) |
| Evening, night and weekend shifts | n=24 | ||
| 24/7 a surgeon specialised in gastrointestinal oncology is ‘on call’ (he/she does not have to be in the hospital, though is available for consultation)* | 65 | 170 (5–15) | 1.83 (SD 1.167) |
| A surgeon specialised in gastrointestinal oncology is present at ward rounds in weekends | 14 | 18 (0–8) | 2.96 (SD 1.628) |
| Surgeon ‘on call’ is present at the evening report | 11 | 20 (10–10) | 3.58 (SD 1.558) |
| The emergency room is 24/7 accessible | 8 | 10 (10–10) | 3.08 (SD 1.283) |
| Presence of a surgeon in the hospital 24/7 | 3 | 10 (10–10) | 4.92 (SD 1.349) |
| Presence of a resident in the hospital 24/7 | 0 | 0 | 4.63 (SD 1.245) |
| Communication | n=24 | ||
| Communication between nurses and interns, residents or surgeons | 30 | 63 (3–12) | 1.54 (SD 0.779) |
| Communication between surgeons | 24 | 45 (5–10) | 2.13 (SD 0.741) |
| At least monthly discussion of outcomes (including discussion of complications) | 19 | 55 (5–15) | 3.46 (SD 0.932) |
| Communication between surgeon and anaesthesiologist | 8 | 15 (5–10) | 2.88 (SD 0.992) |
| Healthcare providers | n=24 | ||
| Average experience of nurses on the wards | 30 | 70 (2–20) | 1.75 (SD 0.737) |
| Average experience of interns and residents responsible for the wards | 11 | 18 (8–10) | 2.63 (SD 1.173) |
| The hospital is a referral centre for colorectal surgery | 5 | 5 (5–5) | 2.75 (SD 1.073) |
| No of nurses per patient (nurse/patient ratio) | 5 | 5 (5–5) | 2.88 (SD 1.154) |
| No of surgeons specialised in gastrointestinal oncology in a hospital | 5 | 10 (10–10) | 4.29 (SD 1.628) |
| Hospital structure | n=24 | ||
| No of colorectal surgeries (both benign and malignant) performed in the hospital annually* | 46 | 103 (2–20) | 2.42 (SD 1.586) |
| Presence of emergency intervention team | 24 | 53 (2–15) | 2.54 (SD 1.668) |
| Accessibility of an intervention radiologist | 19 | 35 (5–10) | 4.17 (SD 1.633) |
| The ICU level of the hospital | 11 | 30 (5–20) | 4.08 (SD 1.381) |
| The operating team also performs other high-complex surgeries | 8 | 17 (2–10) | 3.5 (SD 1.445) |
*Ten most important factors are marked with.
CRP, C reactive protein; ICU, intensive care unit.