Colorectal surgery in rural Australia: Scars; A surgeon-based audit of workload and standards

Background: The collection and measurement of colorectal surgical workload, case management and clinical indicators have been mainly based on metropol itan specialist institutions. The aim of the present study was to examine t he workload and standards of colorectal surgery in rural Australia. Methods: Sixty-nine rural general surgeons in Victoria, Albury and South Au stralia were invited to complete a questionnaire for each transabdominal co lorectal operation performed over a 12-month period from 1 May 1996. Data w ere collected on comorbidity, operation detail, pathology, complications an d intention to use adjuvant cancer therapy. Results: Sixty-two surgeons contributed 877 data forms. The patient average age was 65 years with 60% having pre-existing disease. One-third of operat ions were emergency presentations of which bowel obstruction was the most c ommon. An anastomosis was performed in 675 patients of whom 22 (3.3%) had a clinical anastomotic leak. For low rectal anastomosis the leak rate was 8. 9%. Two-thirds of patients had colorectal cancer and 42% of these cancer pa tients had advanced (Australian clinicopathological stage C or D) disease. The perioperative mortality rate was 4.6% but in the presence of more than two comorbidities it was 16.4%. Mortality was higher with emergency present ations (8.3%), particularly in patients older than 80 years (15.2%). Conclusions: The study sampled a very high percentage of rural colorectal s urgery performed during the audit period. Colorectal surgery clinical indic ators were comparable to other Australian studies. Anti-thrombotic and adju vant therapy were identified as two areas requiring further education. Majo r surgery is being performed regularly in south-eastern rural Australia at a consistently high standard by surgeons who live and work in their rural c ommunity.