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Purpose: The National Bowel Cancer Audit Project (NBOCAP) collects data from hospitals in the UK and aims to improve surgical outcomes and quality of care for patients. The aims of this study were to understand why trusts were/were not participating in the NBOCAP and how to improve the quality of data collected and feedback. Methods: This was a prospective e-survey on colorectal surgeons' attitudes towards and opinions of the NBOCAP, within trusts in the UK. A questionnaire was emailed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI). Results: Of the 171 trusts contacted by email, 66% of trusts ( n = 117) had at least 1 consultant respond. Of the 117 trusts that responded, 60 (51.2%) had submitted data to the NBOCAP. A total of 549 consultants received the questionnaire, and 159 (29.0%) consultants responded. Fifty-one per cent ( n = 60) of the trusts had submitted data to the NBOCAP. Reasons for data submission included the following: comparison of a units' data with national data (56.8%), a national audit improves outcomes (45.9%) and generation of information for use at a local level (42.6%). The main reasons for non-submission were as follows: lack of technical support (23.6%), lack of funding (19.6%) and lack of dedicated audit time (18.9%). Ninety-six (60.4%) consultants felt that the audit report should identify individual trust results. Fifty-three per cent of consultants ( n = 87) rated their trusts' resources for audit as being very poor or poor. Conclusion: Consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) within hospital trusts in the UK feel participation in the National Bowel Cancer Audit improves patients' quality of care and surgical outcomes. Increased awareness of the benefits of the NBOCAP and improved allocation of resources from hospital trusts could improve participation. [ABSTRACT FROM AUTHOR]

The article identifies risk factors predictive of secondary proctectomy due to rectal cancer by reviewing data from 427 cases in which patients with a diagnosis of familial adenomatous polyposis (FAP) underwent ileorectal anastomosis (IRA) at St. Mark's Hospital in Great Britain from 1925 to 2008. The results revealed that 29.3% of patients who had an IRA had rectal failure over a median follow-up of 15 years, while factors like the patient's genotype, phenotype and age during surgery determines the risk of proctectomy after IRA.

Background The government’s proposals to openly report clinical outcomes poses challenges to the National Bowel Cancer Audit now funded by the UK department of health. Aim To identify the benefits and risks of open reporting and to propose ways the risks might be minimized. Methods A review of the literature on clinical audit and the consequences of open reporting. Results There are significant potential benefits of a national audit of bowel cancer including protecting patients from sub-standard care, providing clinicians with externally validated evidence of their performance, outcome data for clinical governance and evidence that increases in government expenditure are achieving improvements in survival from bowel cancer. These benefits will only be achieved if the audit captures most of the cases of bowel cancer in the UK, the data collected is complete and accurate, the results are risk adjusted and these are presented to the public in a way that is fair, clear and understandable. Involvement of clinicians who have confidence in the results of the audit and who actively compare their own results against a national standard is essential. It is suggested that a staged move to open reporting should minimise the risk of falsely identifying an outlying unit. Conclusion The fundamental aim of the National Bowel Cancer Audit is the pursuit of excellence by identification and adoption of best practice. This could achieve a continuous improvement in the care of all patients with bowel cancer in the UK. The ACPGBI suggests a safer way of transition to open reporting to avoid at least some of its pitfalls. [ABSTRACT FROM AUTHOR]

Objective There is little information on the long-term failure and function after restorative proctocolectomy (RPC). The results of data submitted to a national registry were analysed. Method The UK National Pouch Registry was established in 2004. By 2006, it comprised data collected from ten centres between 1976 and 2006. The long-term failure and functional outcome were determined. Trends over time were assessed using the gamma statistic or the Kruskal–Wallis statistic wherever appropriate. Results In all, 2491 patients underwent primary RPC over a median of 54 months (range 1 month to 28.9 years). Of these, 127 (5.1%) underwent abdominal salvage surgery. The incidence of failure (excision or indefinite diversion) was 7.7% following primary and 27.5% following salvage RPC ( P < 0.001). The median frequency of defaecation/24 h was five including one at night. Nocturnal seepage occurred in 8% at 1 year, rising to 15.4% at 20 years ( P = 0.037). Urgency was experienced by 5.1% of patients at 1 year rising to 9.1% at 15 years ( P = 0.022). Stool frequency and the need for antidiarrhoeal medication were greater following salvage RPC. Conclusion In patients retaining anal function after RPC, frequency of defaecation was stable over 20 years. Faecal urgency and minor incontinence worsened with time. Function after salvage RPC was significantly worse. [ABSTRACT FROM AUTHOR]

The article presents a meta-analysis on the effect of the antiplatelet agent clopidogrel following a coronary artery bypass grafting in Great Britain. Clopidogrel is a thienopyridine derivative with a structure and mechanism of action that is distinct from other clinically available antiplatelet agents. This study found that postoperative complications increased significantly for patients taking clopidogrel undergoing cardiac surgery.

Aim: To investigate the factors that predict list overruns in a National Health Service (NHS) day surgery unit. Methods:Multivariate logistic regression was used to investigate the independent influence of operating list size, late starts, individual personnel and session factors on general surgical list overruns. Results:30%(627/2092) of all ambulatory general surgical lists performed over a 7 year period overran. Regression modelling revealed that operating list size was the main predictor of overruns in this context(p<0.001). Individual surgeons(p<0.001) and late-starting lists(p<0.001) also influenced whether overruns occurred but to a lesser degree. Discussion:Reducing overruns in NHS ambulatory centres is desirable. Achieving this through reduced list size requires local prioritisation between opposing operational targets. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between organisational structure, process and surgical outcomes for bowel cancer surgery., Methods: An e-survey was sent to the members of the Association of Coloproctology of Great Britain and Ireland to determine the organisational structure of their Trusts. Responses were combined with the National Bowel Cancer Audit (NBOCAP) data. Items investigated included; number of consultants, nurse specialists, volume of cases and intensive care facilities. Main outcome measures included: 30-day risk-adjusted mortality, length of stay (LOS), lymph node yield and circumferential margin involvement (CRM)., Results: One hundred and seventeen Trusts responded (65.8%), matched to 7666 patient episodes (NBOCAP data) from 54 (62.8%)Trusts who submitted data to the audit. Trusts treating <190 cases/annum (p > 0.001), <4 colorectal consultants (p > 0.001), <4 HDU beds (p > 0001) and <8 ITU beds (p > 0001) were more likely to have a 30-day-risk-adjusted mortality twice that of the national mean. Sixty five percent (n = 1603) of Trusts treating ≥ 190 cases/annum harvested ≥ 12 lymph nodes vs. 58.3% (n = 1435) in Trusts <190 cases/annum (p < 0.001). Trusts with ≥ 2 pathologists with an interest in bowel cancer harvested ≥ 12 lymph nodes more frequently (p=<0.001) and were more likely to identify extramural vascular invasion in the specimen (p = 0.015). Negative CRM was achieved in 81.4% (n = 81.4) of patients in Trusts treating ≥ 190 cases vs. 66.5% (n = 569) in Trusts<190 cases/annum (p < 0.001). Trusts offering fast track discharge were more likely to have a LOS < 15 days (p = 0.006). Surgeons treating ≤ 35 cases/annum had increased major post-operative complications (<35 cases = 70.2% vs. ≥ 35 cases = 21.9%; p < 0.001), however 30 day risk adjusted mortality was not increased in surgeons treating <35 cases/annum., Conclusions: This study shows that the organisational infrastructure of hospitals appears to have as great an impact on patient outcomes as the volume of cases performed by hospital Trusts., (Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.)

Background: Utilization is used as the principal marker of theatre performance in the NHS. This study investigated its validity as: a managerial tool, an inter-Trust indicator of efficient theatre use and as a marker of service performance for surgeons., Methods: A multivariate linear regression model was constructed using theatre data comprising all elective general surgical operating lists performed at a NHS Teaching hospital over a seven-year period. The model investigated the influence of: operating list size, individual surgeons and anaesthetists, late-starts, overruns, session type and theatre suite on utilization (%)., Results: 7,283 inpatient and 8,314 day case operations were performed on 3,234 and 2,092 lists respectively. Multivariate analysis demonstrated that the strongest independent predictors of list utilization were the size of the operating list (p < 0.01) and whether the list overran (p < 0.01). Surgeons differed in their ability to influence utilization. Their overall influence upon utilization was however small., Conclusion: Theatre utilization broadly reflects the surgical volume successfully admitted and operated on elective lists. At extreme values it can expose administrative process failure within individual Trusts but probably lacks specificity for meaningful use as an inter-Trust theatre performance indicator. Unadjusted utilization rates fail to reflect the service performance of surgeons, as their ability to influence it is small.