EP627 - CoReAL value and feasibility

Image or Table (Do Not add text here): Figure 1. Survey results on the questions regarding feasibility and relevance of the reporting elements and themes of the domain of feasibility. The x-axis displays the percentage of responses of agreement and disagreement. The y-axis represents phases in time.

Purpose/Background: The Consensus on Reporting colorectal Anastomotic Leaks (CoReAL) project, funded by the ASCRS research foundation, was created to build a framework to standardize reporting of colorectal anastomotic leaks (ALs) based on evidence and expert consensus. The framework is composed of 43 elements across 4 phases of the AL episode: preoperative, operative, and short and long-term postoperative. The present study aims to describe current practices of reporting AL and explore perceptions regarding value and feasibility of the CoReAL framework.

Methods/Interventions: This study employed a mixed-methods approach, combining an online survey (administered via email using Google Forms) with focus group discussions. The online survey explored providers ideas on the relevance and feasibility of the framework. Focus groups were conducted in-person and virtually. Thematic analysis was performed using an abductive approach and the framework method to identify domains and associated themes. Participants were recruited through purposive sampling through surgical societies (ASCRS, SAGES and EAES), including surgeons, nurses and residents.

Results/Outcomes: A total of 172 participants completed the survey, and 35 took part in 12 focus groups, representing 33 countries in total. The survey indicated that the majority (75.6%) believed the framework could enhance quality of care. Reporting of the CoReAL preoperative and operative elements was deemed feasible by 69.2% and 91.3% of respondents respectively, and reporting at the 30-day postoperative follow-up by 83.1%. While 72.0% agreed that reporting beyond the 90 day postoperative period was relevant, reporting up to and beyond 90 days was considered feasible by 64.6% and 55.8% of participants, respectively. Focus group analysis revealed that the framework was seen as valuable and feasible. Four key domains emerged: (1) Current reporting practices; (2) Perceptions of the framework; (3) Feasibility and relevance; and (4) Future directions. Most participants reported leaks at individual, institutional, and national levels, with some describing selective reporting due to fear of consequences. Perceived benefits included improving patient outcomes, standardizing research, aiding surgeons in risk assessments and leak management, and reducing healthcare costs. Concerns were raised about the impact on surgeons' reputation and medical liability with transparent reporting. The framework was viewed as well-structured and unique in including patient perspectives. While preoperative and operative data reporting was seen as feasible, long-term postoperative follow-up posed more challenges. Participants identified several future directions for the framework, including the establishment of new surgical standards.

Conclusion/Discussion: Overall, participants agreed that a standardized longitudinal reporting framework for colorectal AL would be feasible to implement into clinical practice. While most considered long-term reporting of outcomes relevant, agreement on feasibility declined for follow-up beyond 30 days. Despite the challenges identified in current reporting of leaks, the CoReAL framework was perceived as a valuable tool to improve quality of care and improve outcomes.