Compliance with the American Society of Colon and Rectal Surgeons Preoperative Checklist in Rectal Cancer Care in Ghana: Gaps and Opportunities for Improvement - A Cross-Sectional Study.

Abstract

Colorectal cancer is the third most common cancer worldwide, with increasing incidence and mortality expected in the coming decades. In Ghana, its burden is growing, and this has been addressed through training skilled colorectal surgeons and adopting international protocols. This study aimed to evaluate adherence to the American Society of Colon and Rectal Surgeons preoperative colorectal cancer checklist and its association with postoperative outcomes in two teaching hospitals in Ghana. A cross-sectional study was conducted on rectal cancer patients treated at two major teaching hospitals in Ghana. Chart reviews were done retrospectively to assess the completion of checklist items and their relationship with 30-day morbidity and mortality, comparing patients who completed the median number or more items to those who completed fewer. Fifty-two rectal cancer cases were included. Males (53. 9%) were the majority, with a mean age of 56 years. Most patients were diagnosed at stage III (69. 2%). The median number of completed checklist items was 6, with no patient completing all 10 items. The checklist items with the highest completion rates were clinical tumor staging (100%) and pathology review (100%). Assessments of family history, stool continence, sexual function, and stoma site marking were the least frequently completed. There was a significant difference in checklist completion between the two hospitals (p = 0.030). Checklist adherence was not significantly linked to postoperative morbidity or mortality. Adherence to the preoperative checklist provides a systematic approach to patient evaluation in preparation for surgery, though it did not influence morbidity or mortality in this study. Establishing dedicated colorectal units is a key step toward improving surgical outcomes and overall patient survival.