Introduction Permanent stoma rates following surgical resection for rectal cancer in England and Wales were reported in the 2012 National Bowel Cancer Audit (NBOCA), for patients diagnosed between 01/08/2008 – 31/07/2010. The report rate for Northumbria Healthcare NHS Trust was 71.7%, resulting in a notification letter from the NHS Information Centre that the rate was higher than expected. This study aimed to establish the permanent stoma rate for patients undergoing formal resection with a date of diagnosis of rectal cancer 01/04/2010–31/03/2013 and assess against the NBOCA reported rate for the prior cohort and the national average of 51% from the 2013 NBOCA report.
Method Data were exported from a clinician maintained, prospectively populated database of all patients with colorectal cancer known to the multi-disciplinary team. Permanent stoma rates were calculated by subtracting primary surgery and stoma creation dates from the date of reversal where present. Presence of a stoma >547.5 days (18 months) after primary surgery was regarded permanent, as defined by NBOCA.
Results One hundred and eighty-three patients underwent an elective major resection surgery for rectal cancer in this 3 year cohort. The majority (168, 91.8%) had a stoma raised at the time of primary surgery. One patient required a stoma after a return to theatre for anastomotic leak. Of the 102 stomas raised with temporary intent, 80.4% were reversed by 18 months. Reasons for failure to reverse included leaks, disease progression with metastases, debility, death and patient choice. The final permanent stoma rate in patients who underwent major resection was 47.5%.
Conclusion This Trust’s stoma rates are in line with the national average and not therefore a cause for concern. This audit did cover a more recent cohort of patients to the 2012 and 2013 NBOCA reports so direct comparisons cannot be made, but stoma rates are unlikely to have changed so significantly. This does raise the question of whether the NBOCA reported rates, derived partly from Open Exeter and partly from Hospital Episode Statistics, are misleading. Accurate granular data requires clinician involvement for capture and submission. The new NBOCA audit platform does facilitate contemporaneous data capture by clinical teams, but is no longer trying to capture this quality metric. It is in the interest of clinical teams and their patients to collect and own their data.
Disclosure of interest None Declared.
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