Effect of a colorectal bundle in an entire healthcare region in Switzerland: results from a prospective cohort study (EvaCol study).

Jürg Metzger, Marco von Strauss Und Torney, Jörn-Markus Gass, Markus von Flüe, Daniel Stimpfle, Martina Pabst, Alexandra Müller, Carsten T Viehl, Christian Nebiker, Mark Henschel, Mathias Worni, Lukas Eisner, Raffaele Galli, Robert Rosenberg, Benjamin Wiesler, Beat P Müller, Ralph Peterli, Laura Werlen, Urs Zingg, Mark Hartel, Markus Zuber

Journal: International journal of surgery (London, England) 2025;110(12):7763-7774

PMID: 39453984

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Abstract

INTRODUCTION

Standardization has the potential to serve as a measure to mitigate complication rates. The objective was to assess the impact of standardization by implementing a colorectal bundle (CB), which comprises nine elements, on the complication rates in left-sided colorectal resections.

PATIENTS AND METHODS

This prospective, multicentre, observational, cohort trial was conducted in Switzerland at nine participating hospitals. During the control period, each patient was treated in accordance with the local standard protocol at their respective hospital. In the CB period, all patients were treated in accordance with the CB. The primary endpoint was the Comprehensive Complication Index (CCI) at 30 days.

RESULTS

A total of 1141 patients were included (723 in the No CB group and 418 in the CB group). The median age was 66 years, and 50.6% were female. Median CCI before and after CB implementation was 0.0 (interquartile range [IQR]: 0.0-20.9). A hurdle model approach was used for the analysis. The CB was not associated with the presence or severity of complications. Older age (odds ratio [OR] 1.02, 95% CI: 1.00-1.03), surgery for malignancy (OR 1.34, 95% CI: 1.01-1.92), emergency surgery (OR 2.19, 95% CI: 1.31-3.41), elevated nutritional risk score (OR 1.13, 95% CI: 1.01-1.24), and BMI (OR 1.04, 95% CI: 1.00-1.06) were associated with higher odds of postoperative complications. In a supplementary per-protocol analysis, for each additional item of the CB fulfilled, the odds of anastomotic leakage (AL) were 24% lower (OR 0.76, 95% CI: 0.64-0.93).

CONCLUSIONS

Dedicated teams can establish high-quality colorectal services in a network of hospitals with a joint standard. The study can serve as a model for other healthcare settings to conduct and implement quality improvement programs. The consistent implementation of the CB items can reduce the occurrence of AL.

Address: Department of Visceral Surgery, University Digestive Health Care Center, Basel, Switzerland.; Department of Visceral Surgery, Cantonal Hospital of Basel-Land, Liestal, Switzerland.; Department of Visceral Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.; Department of Visceral Surgery, University Digestive Health Care Center, Basel, Switzerland.; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.; Department of Visceral Surgery, Lindenhofspital, Bern, Switzerland.; Department of Visceral Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland.; Department of Surgery, Spitalzentrum Biel, Biel, Switzerland.; University of Basel, Basel, Switzerland.; Department of Surgery, Spitalzentrum Biel, Biel, Switzerland.; Department of Surgery, Cantonal Hospital of Olten, Olten, Switzerland.; Chirurgieaarau AG, Aarau, Switzerland.; Department of Visceral Surgery, Limmattal Hospital, Zurich-Schlieren, Switzerland.; Chirurgie Zentrum Zentralschweiz, Lucerne, Switzerland.; Department of Visceral Surgery, University Digestive Health Care Center, Basel, Switzerland.; St. Clara Research Ltd., St. Clara Hospital, Basel, Switzerland.; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.; Department of Visceral Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.

DOI: 10.1097/JS9.0000000000002123

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MeSH Terms: Humans, Female, Male, Switzerland, Aged, Prospective Studies, Middle Aged, Postoperative Complications, Patient Care Bundles, Colorectal Neoplasms, Aged, 80 and over