American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New rectal cancer accreditation program chases Europe’s success

Tuesday, October 24, 2017
Clinical Congress Daily Highlights, Tuesday First Edition

The new National Accreditation Program for Rectal Cancer (NAPRC) owes its existence to a simple health disparity: For years, outcomes for rectal cancer patients in Europe have been significantly better than for those in the U.S.

The performance gap began to develop at least a decade ago, said Steven D. Wexner, MD, FACS, Cleveland Clinic Florida, Weston, FL, who described the “rationale and reality” of the new program on Tuesday.

“We’re finally reacting to it. For many years, we’ve kind of had our heads in the sand,” he said.

For instance, even a decade ago the rates of colostomy in Europe ranged from 25 percent to 35 percent, while today’s colostomy rate in the U.S. is about 50 percent. Rectal cancer cases in the U.S. have an average circumferential resection margins (CRMs) rate of 17 percent, significantly higher than the 3 percent to 11 percent range for European countries.

In 2011, the Consortium for Optimizing Surgical Treatment of Rectal Cancer (OSTRICH) was created to improve rectal cancer care. But it wasn’t until OSTRICH began to collaborate with the American College of Surgeons (ACS) and its Commission on Cancer that the NAPRC really began to take off.

“ACS has a system of quality improvement based on setting standards, establishing the right infrastructure, developing rigorous data, and verification,” Dr. Wexner emphasized.

And the standards work. For example, ACS National Surgical Quality Improvement Program (ACS NSQIP®) hospitals showed a 66 percent improvement in mortality and 82 percent improvement in reducing complication rates overall, according to a study.

Looking at the practice of rectal cancer surgery in Europe, it was discovered that one of the reasons for the better outcomes was the establishment of multidisciplinary care teams that were collectively responsible for making treatment decisions about therapy, surgical approach, and the timing of surgery. Establishing and using multidisciplinary care teams, which must include members from surgery, pathology, radiology, medical oncology, and radiation oncology, is a requirement for NAPRC accreditation, he said.

Another requirement is the use of synoptic patient and pathology reports rather than narrative reports, which have been typical until now. Synoptic reporting is a clinical documentation method that uses structured checklists — although there is also space for narrative reporting. Synoptic reports have been shown to collect 99 percent of critical patient data, while narrative reports typically capture less than 50 percent, according to studies on the subject, Dr. Wexner said.

With ACS strongly behind the program, “we have a unique opportunity to improve outcomes for rectal cancer in the U.S, like they’ve done in Europe,” Dr. Wexner said.

Additional Information:
The Named Lecture, The Rationale for and Reality of the New ACS CoC National Accreditation Program for Rectal Cancer, was held October 24, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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