Improving Colorectal Cancer Surgical Outcomes Through Audit and Feedback: Results From the Emilia Romagna ESCA Program
Author(s)
Valentina Danesi, MEng, PhD1, Parisa Soleimani, MD2, Andrea Lucchi, MD3, Alban Cacurri, MD3, Davide Cavaliere, MD4, Francesco Pasini, MD4, Banchini Filippo, MD5, Andrea Romboli, MD5, Giorgio Ercolani, MD, PhD2, Leonardo Solaini, MD2, Mattia Portinari, MD6, Basilio Pirrera, MD6, Fausto Catena, MD, PhD7, Giacomo Stacchini, MD7, Giampaolo Ugolini, MD, PhD2, Giacomo Frascaroli, MD8, William Balzi, MEng1, Nicola Gentili, MSc1, Giacomo Ferri, MSc1, Ilaria Massa, BSc1, Alice Andalo', MEng1, Andrea Roncadori, MSc1.
1IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy, 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy, 3UOC Chirurgia Generale Bariatrica, Ceccarini Hospital, AUSL Romagna, Riccione, Italy, 4UOC Chirurgia Generale, Degli Infermi Hospital, AUSL Romagna, Faenza, Italy, 5UOC Chirurgia Generale, Piacenza Hospital, AUSL Piacenza, Piacenza, Italy, 6UOC Chirurgia Generale, Infermi Hospital, AUSL Romagna, Rimini, Italy, 7General, Emergency and Trauma Surgery Department, Bufalini Hospital, AUSL Romagna, Cesena, Italy, 8Colorectal and General Surgery, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
1IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy, 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy, 3UOC Chirurgia Generale Bariatrica, Ceccarini Hospital, AUSL Romagna, Riccione, Italy, 4UOC Chirurgia Generale, Degli Infermi Hospital, AUSL Romagna, Faenza, Italy, 5UOC Chirurgia Generale, Piacenza Hospital, AUSL Piacenza, Piacenza, Italy, 6UOC Chirurgia Generale, Infermi Hospital, AUSL Romagna, Rimini, Italy, 7General, Emergency and Trauma Surgery Department, Bufalini Hospital, AUSL Romagna, Cesena, Italy, 8Colorectal and General Surgery, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
OBJECTIVES: Colorectal cancer (CRC) is among the most common malignancies worldwide. Despite advances in surgical techniques, significant inter-institutional disparities in clinical outcomes persist. Audit and Feedback (A&F) is a recognised strategy to reduce variability and promote best practices. This study aimed to evaluate the impact of the Emilia-Romagna Surgical Colorectal Audit (ESCA), launched in 2019 as Italy's first multicenter A&F program for CRC surgery.
METHODS: This retrospective, multicenter, observational study included patients undergoing CRC surgery between 2019 and 2024 across seven surgical units in the Emilia-Romagna region. Over 170 perioperative variables were collected via structured forms. The evaluated outcomes, adjusted for case-mix, included postoperative complications, reinterventions, readmissions, and mortality at 30 days, as well as mortality at 180 days and length of stay (LoS). Annual anonymised reports were distributed, allowing performance benchmarking across centres.
RESULTS: A total of 3,604 patients were enrolled, representing approximately 93% of the eligible cases. The collection of non-surgical data remained a limitation, with less than 50% of the pelvic magnetic resonance data and only 58% of the pathology reports fully captured. Following ESCA implementation, the average length of stay (LoS) decreased from 6.2 to 4.8 days (-7% ceteris paribus, i.e. adjusting for covariates), resulting in a savings of 1,395 hospital days. Use of minimally invasive surgery for rectal cancer increased by 6.5%. Rates of reintervention (3.3%) and mortality (<2% at 30 days; <5% at 180 days) remained stable. Unfortunately, a 34% overall increase in readmission was observed, with marked variability across centres (-24.7% to +139.7%).
CONCLUSIONS: The ESCA A&F project shows promising indications of effectiveness in improving CRC surgical outcomes. Nonetheless, some heterogeneity among centers suggests differential responsiveness to A&F. Further qualitative investigation into local audit dynamics and contextual determinants is warranted to optimize implementation and impact.
METHODS: This retrospective, multicenter, observational study included patients undergoing CRC surgery between 2019 and 2024 across seven surgical units in the Emilia-Romagna region. Over 170 perioperative variables were collected via structured forms. The evaluated outcomes, adjusted for case-mix, included postoperative complications, reinterventions, readmissions, and mortality at 30 days, as well as mortality at 180 days and length of stay (LoS). Annual anonymised reports were distributed, allowing performance benchmarking across centres.
RESULTS: A total of 3,604 patients were enrolled, representing approximately 93% of the eligible cases. The collection of non-surgical data remained a limitation, with less than 50% of the pelvic magnetic resonance data and only 58% of the pathology reports fully captured. Following ESCA implementation, the average length of stay (LoS) decreased from 6.2 to 4.8 days (-7% ceteris paribus, i.e. adjusting for covariates), resulting in a savings of 1,395 hospital days. Use of minimally invasive surgery for rectal cancer increased by 6.5%. Rates of reintervention (3.3%) and mortality (<2% at 30 days; <5% at 180 days) remained stable. Unfortunately, a 34% overall increase in readmission was observed, with marked variability across centres (-24.7% to +139.7%).
CONCLUSIONS: The ESCA A&F project shows promising indications of effectiveness in improving CRC surgical outcomes. Nonetheless, some heterogeneity among centers suggests differential responsiveness to A&F. Further qualitative investigation into local audit dynamics and contextual determinants is warranted to optimize implementation and impact.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO146
Topic
Clinical Outcomes, Organizational Practices
Topic Subcategory
Comparative Effectiveness or Efficacy, Performance-based Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology