EP618 - Compliance with the ASCRS Preoperative Checklist in Rectal Cancer Care in Ghana: Gaps and Opportunities for Improvement

Monday, May 12, 2025

8:16 AM – 8:21 AM PT

Location: Monitor 3, Sails Pavilion, Upper Level

ePoster Presenter(s)

KA

Kwabena Agbedinu, MBCHB, DPDM, FWACS, FGCS (he/him/his)

SNR SPECIALIST GENERAL SURGEON
KOMFO ANOKYE TEACHING HOSPITAL
KUMASI, Ashanti, Ghana

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AB

Antoinette Afua Asiedua Bediako-Bowan, MBChB, FWACS, PhD, FGCS

Associate Professor
University of Ghana Medical School
ACCRA, Greater Accra, Ghana

Disclosure information not submitted.
SB

Samuel Gyasi Brenu, MWACS

Specialist Surgeon
Komfo Anokye Teaching Hospital
Kumasi, Ashanti, Ghana

Disclosure information not submitted.
CA

Cynthia Akli-Nartey, Member, West African College of Surgeons (MWACS): Member, Ghana College of Physicians and Surgeons (MGCPS)

SPECIALIST SURGEON
KORLE-BU TEACHING HOSPITAL
Accra, Greater Accra, Ghana

Disclosure information not submitted.
PK

Philemon K. Kumassah, MBChB, FWACS

Senior Specialist General Surgeon
Korle-bu Teaching Hospital, Accra, Ghana
Accra, Greater Accra, Ghana

Disclosure information not submitted.
CD

Charles K. Dally, MD, FICS, FGCS, FWACS

Consultant General Surgeon
1. Komfo Anokye Teaching Hospital 2. Kwame Nkrumah University of Science and Technology
Kumasi, Ashanti, Ghana

Disclosure information not submitted.
JY

Joseph Yorke, MD, FA Chirurgie, FGCS, FWACS

Head of Surgery Department, Head of Genaral Surgery Unit
Kwame Nkrumah University of Science and Technology
Kumasi, Ashanti, Ghana

Disclosure information not submitted.
Ann Lowry, MD (she/her/hers)

Adjunct Professor of Surgery
University of MInnesota
University of Minnesota
Minnetonka, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Jonathan A. Laryea, MD

Professor
University of Arkansas for Medical Sciences
University of Arkansas for Medical Sciences
Little Rock, AR, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
LH

Lyen C. Huang, MD, MPH

Associate Professor
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.

Senior Author(s)

Gifty Kwakye, MD MPH

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Kwabena Agbedinu, MBCHB, DPDM, FWACS, FGCS: This individual has no financial relationships with ineligible companies.

Ann Lowry, MD: This individual has no financial relationships with ineligible companies.

Jonathan A. Laryea, MD: This individual has no financial relationships with ineligible companies.

Gifty Kwakye, MD MPH: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Colorectal cancer (CRC) is a growing public health concern in Ghana, with an estimated 5-year survival rate of only 16%. The World Health Organization (WHO) Surgical Safety Checklist has been instrumental in reducing surgical complications globally by providing a framework for essential intraoperative safety checks. However, rectal cancer requires an additional level of complexity due to the intricacies of staging, treatment planning, and multidisciplinary coordination. Recognizing these challenges, the American Society of Colon and Rectal Surgeons (ASCRS) developed a rectal cancer-specific checklist to complement the WHO checklist. The ASCRS checklist addresses not only intraoperative safety but also critical preoperative and postoperative phases, ensuring comprehensive care. However, the degree to which this checklist is followed in low-resource settings like Ghana remains unclear. This study aims to evaluate compliance with the preoperative portion of the ASCRS checklist at two major teaching hospitals in Ghana, identifying areas for improvement to enhance care quality and patient outcomes.

Methods/Interventions: A retrospective cross-sectional study was conducted on rectal cancer patients who underwent surgery from January 2022 to December 2023 at two teaching hospitals in Ghana. Compliance with the ASCRS preoperative checklist was assessed, and associations with postoperative morbidity and mortality were evaluated. Statistical analyses were performed using Pearson’s Chi-square and Fisher’s exact tests, with significance defined at p< 0.05.

Results/Outcomes: A total of 52 rectal cancer patients were included in the study. The overall compliance with the ASCRS preoperative checklist (number of items completed) was 53.9%, with no patient having all 10 items completed. The most adhered-to items were clinical staging of the tumor and formal pathology reviews (100%), while assessments of stool continence and sexual function, along with preoperative stoma site marking, had the lowest completion rates (13.5% and 1.9%, respectively). No significant association was found between checklist compliance and postoperative morbidity (p=0.27) or 30-day mortality (p=0.24).

Conclusion/Discussion: This study highlights significant gaps in preoperative care for rectal cancer patients in Ghana, particularly regarding adherence to key elements of the ASCRS checklist. Future studies should focus on understanding the barriers to checklist adherence in this local low-resourced context and identifying strategies to improve its consistent implementation. Ensuring the sustainability of checklist use will be critical for enhancing care quality and optimizing patient outcomes.