Northland study finds more than a quarter of bowel cancer surgery patients suffered a complication

Christchurch surgeon Tamara Mullaney says strategies are needed to reduce complications from bowel cancer surgery.

Doctors are pushing for the health system to invest in ways of reducing surgical complications in bowel cancer patients.

Laila Sheikh, of Middlemore Hospital, and colleagues have studied bowel cancer surgery complications at Northland District Health Board.

Of 390 bowel cancer surgery patients in the study, 107 - more than a quarter - suffered a complication, they write in today's NZ Medical Journal.

The median cost of surgery was $28,485 with complications and $14,697 without.

Complications of bowel cancer surgery can include blood clots, bowel obstruction, bleeding, heart trouble, leaking of surgical joins, and infection.

"Significant investment in initiatives to reduce complications is justified."

In an editorial article in the journal, Tamara Mullaney and Timothy Eglinton, of the surgery department at Otago University, Christchurch, cite a United States surgical quality improvement programme which finds what works best and gets that introduced as standardised care. It was associated with a 31 per cent reduction in the death rate of patients in the weeks after surgery.

"In New Zealand, the Bowel Cancer Quality Improvement Report was recently released detailing the relative performances of the district health boards on six measures of surgical quality …"

Among the measures were death rate after surgery, rate of emergency surgery, length of stay and whether at least 12 lymph nodes were examined.

"This demonstrated the diversity in presentation and types of treatment received across the different DHBs, although there is some debate over the relevance of some of the measures both in terms of their validity as measures of quality and the completeness of the data collected."

"Cost-efficiency in healthcare delivery is a basic necessity in the current economic climate; the only way to ensure this is through prospective, relevant and ongoing audit."

"Audit should identify areas for improvement and inform the required systematic changes to minimise negative outliers, ultimately driving quality improvement and minimising the cost of complications."