Why Certification of Colorectal Cancer Centres Does Not Improve Surgical Quality

Abstract

To improve treatment results, certification of colorectal cancer centres in Germany assures interdisciplinary treatment according to official treatment guidelines. The treatment results of certified colorectal cancer centres are published annually. Despite certification, the surgical quality indicators of anastomotic leakage, wound infection, and revision surgery have not improved between 2009 and 2015. Patients with anastomotic leakage (AL) after colorectal resection of an adenocarcinoma were analyzed in a Morbidity and Mortality (M+M) conference structured according to the London Protocol. The results were compared to structure and process parameters that are part of the data entry form (DEF) of the Deutsche Krebsgesellschaft (DKG) used for the certification of colorectal cancer centres. Between 2015 and 2017, 387 colorectal resections were performed. Of these, 158 resections were performed due to the diagnosis of a colorectal carcinoma. For 13/149 resections with anastomosis, a leak was diagnosed (8.7%). All patients suffering from an AL were analysed in an M+M conference structured according to the London Protocol. For 10/13 patients, abnormalities in structural and procedural quality were found. As regards procedural quality, this included the application of standards (n = 6/10), communication (n = 3/10) and missing but needed results from examinations (n = 1/10). As regards structural quality, insufficient physical resources were predominant (n = 3/10). Only one of these abnormalities was identified using the DEF. For processes and structures to improve surgical quality, it is required that they have relevant influence on surgical quality. We found that only 1/13 abnormalities detected in the M+M conference structured according to the London Protocol was represented in the DEF. To improve the influence on surgical quality, extensions to the DEF of the Deutsche Krebsgesellschaft should be discussed.