EP942 - Defining delay to definitive surgery of colorectal cancers at single institution: a quality improvement project

Image or Table (Do Not add text here):

Purpose/Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States, with its incidence rising each year. Managing this disease is complex due to the need for a multidisciplinary treatment approach. While early initiation of treatment has been linked to better clinical outcomes, comprehensive data was limited prior to 2020. Delays in elective surgeries during the COVID-19 pandemic prompted a consensus on the optimal timing for oncologic resections to avoid compromising patient outcomes. Evidence now suggests that resection should largely occur within 6 weeks. With this in mind, our quality improvement study aims to evaluate how closely our institution adheres to these recommendations for early-stage colorectal cancer patients undergoing elective oncologic surgical resection, and to assess the impact on patient mortality. Additionally, we will compare our adherence rates to regional averages to identify workflow gaps and explore interventions to minimize treatment delays.

Methods/Interventions: This study employed a retrospective study to investigate the relationship between delay to definitive oncologic resection of colorectal cancer and mortality. Data was collected from electronic health records of patients with cancer of the colon, rectum, or anus who were diagnosed and treated at our intuition. Subjects were included if adult patients (>18 years old) with stage I-III colorectal cancer diagnosed based on tissue pathology between 01/01/2019-12/21/2023. Patients must have undergone elective surgical intervention. Subjects were excluded if they received neoadjuvant treatment before surgery or if they underwent surgery on emergent basis or got entire workup during inpatient stay. Utilization of the Michigan Surgical Quality Collaborative registry will be used to compare our delay to surgery times to regional hospitals. Descriptive statistics will summarize demographic and clinical characteristics. The timing from diagnosis of surgery will be compared between our institution and other hospitals using independent t-tests or Mann-Whitney U tests, depending on the data distribution. Multivariable regression analyses will be conducted to adjust for potential cofounders. Kaplan-Meier survival analysis will be performed to compare overall survival rates between the 2 groups ( < 6 weeks, >6 weeks) at both our intuition and at outside institutions. Ethical approval was obtained from Trinity Health Oakland IRB.

Results/Outcomes: The primary outcome is the time from tissue diagnosis to definitive surgery, with secondary outcomes including 1-year overall mortality and disease-free survival. A total of 368 patients diagnosed with colorectal cancer were initially included in the dataset, with 176 patients meeting all inclusion criteria for analysis. Preliminary data indicated that the average time from tissue diagnosis to definitive surgery was 22 days. Additional data on 1-year overall mortality and disease-free survival are being collected and will be reported upon at presentation.

Conclusion/Discussion: Our institute is committed to optimizing the timing of colorectal surgery resections, recognizing its importance in improving patient outcomes. By benchmarking our performance against other regional institutes, we aim to identify potential areas for improvement within our own practices. The data we collect will serve as a critical step toward enhancing coordination among the various disciplines and potentially hiring a dedicated nurse coordinator within the department.