Outcomes Following Right Hemicolectomy in the Riverina
Jade Enoch1, Tayla Coles1, Stephen Jancewicz1
1. Wagga Wagga Base Hospital, Colorectal Surgery Unit
Introduction
Wagga Wagga Base Hospital (WWBH) is the largest hospital in the Riverina, providing the majority of major surgical and cancer services to residents. This audit aimed to examine outcomes of patients undergoing right hemicolectomy at WWBH compared to the national standard.
Methods
A retrospective database of all patients undergoing right hemicolectomy (MBS item number 32003) at WWBH between 1st January 2017 to 31st December 2018 was collated and analysed. 3 patients were excluded due to coding error. The CSSANZ Bi-National Colorectal Cancer Audit (2018) was used as the national standard for comparison of outcomes.
Results
The total number of right hemicolectomies performed over 24 months was 79. Average age was 67 years (range 20-88), average operating time in minutes 149.74 (range 40-271), and average LOS 13.02 (3-87). 26.5% were emergency cases for either obstruction, ischaemia, or volvulus. 63.2% of right hemicolectomies were performed for malignancy, with 45.5% being performed laparoscopic or lap-assisted. Total mortality rate over 24 months was 22.7% (N=18). Preliminary subgroup analysis of deaths from malignancy (N=12) identified the majority of cancers being of poor biology, with local invasion, nodal disease, or metastases at time of primary resection.
Conclusion
The emergency surgery rate for WWBH was higher than the national average (26.5 vs 6%), however this data is likely skewed due to the inclusion of non-cancer right hemicolectomies performed. Mean LOS was also higher (13.02 vs 8.1), possibly attributed to by geographical distribution of patients. WWBH also has a lower rate of lap or lap-assisted RH (45.5% vs 60%). Unadjusted inpatient mortality rate needs to be examined further.
References
1. Dagher H, Ahern S, Salimi F, Earnest A, Byrne C et al. The Bi-National Colorectal Cancer Audit Report 2019, May 2019, CSSANZ; [cited 21/8/19] https://www.cssanz.org/downloads/brochures/2019_201Data_BCCA_Annual_Report.pdf
2. Tong DK, Law WL. Laparoscopic vs Open Right Hemicolectomy for Carcinoma of the Colon, JSLS, 2007, 11(1): 76-80
3. Lezoche E, Feliciotti F, Guerrieri M et al, Laparoscopic vs Open Hemicolectomy, Minerva Chirurgica, 2003, 58(4), 491-507 [cited 21/8/19 from Cochrane Library]