Towards safer colorectal surgery worldwide: Outcomes and benchmarks from the ESCP CORREA 2022 audit.

Abstract

Benchmarking colorectal surgery outcomes informs quality improvement. The ESCP CORREA 2022 snapshot audit aimed to assess contemporary colorectal resection practices and short-term outcomes across European countries and beyond. An international prospective multicentre audit was conducted in which adults undergoing elective or emergency colorectal resection during a 6-week period (January-April 2022) at participating hospitals were included. Data on patient demographics, indications, surgical approach (open, laparoscopic or robotic) and 30-day postoperative outcomes (complications, reoperation and mortality) were collected for analysis. The outcomes were analysed and compared with those of previous audits to identify trends in colorectal surgery. The study enrolled 3521 patients (56.8% men) from 216 hospitals across 53 countries. In 72.2% of the cases, the indication for resection was malignancy, followed by diverticular disease in 9.0%, Crohn's disease in 3.7% and ulcerative colitis in 2.3% of the cases. Of the surgeries, 74.4% were elective. Minimally invasive surgery was performed in 55.2% of the cases (48.7% laparoscopic and 6.5% robotic). Primary anastomosis was performed in 90.3% of the patients. The 30-day anastomotic leak rate was 7.96%; in malignant and benign diseases, the leak rates were 7.3% and 10.2%, respectively. The leak rates for right, left, anterior rectal resection, pouch and subtotal colectomy were 6.9%, 7.7%, 9.7%, 16.0% and 11.8%, respectively. In the multivariable analysis, the risk factors for leakage included male sex (9.3% vs. 6.3%, OR = 0.69, 95% CI 0.51-0.95, p = 0.023) and emergency surgery (11.4% vs. 7.1%, OR = 1.58, 95% CI 1.10-2.27, p = 0.013). Thirty-day mortality was 2.38%. This large international audit provides the status of the management of colorectal surgery. This shows that minimally invasive techniques are widely adopted, and 30-day mortality is low; however, anastomotic leak rates remain persistently high. These findings highlight the ongoing need for targeted research and quality-improvement initiatives to reduce anastomotic failure and improve outcomes of colorectal surgery.