Best practices in surgery
If you're about to undergo surgery, you want to know that you will receive the best possible care. Dr. Elijah Dixon is developing a method to define what "best" means.
Is there a better way to do this? Even as a medical student, Heritage Population Health Investigator Dr. Elijah Dixon was asking this kind of question. Now it's the focus of his research. The Calgary-based general surgeon, whose clinical specialty is liver and pancreas surgery, has begun a research program to assess surgical procedures.
"It's easy to get caught up in the techniques of surgery and lose sight of the bigger picture: outcomes for patients," he says. "There's a growing recognition that we need to step back and rigorously examine what we do—and not just in surgery, but in all medical specialties."
Dr. Dixon's research goal is to develop a template for the assessment of surgical procedures. As a case study he has chosen a surgery called hepatic resection of metastatic colorectal cancer, which involves removing a portion of the liver. This surgery is an option for many patients whose colorectal cancer (cancer of the colon or rectum) has spread to the liver. Unlike most metastatic cancers, which can spread throughout the body, metastatic colorectal cancer often spreads only to the liver. This means that surgery to remove the cancer from the liver can potentially cure the disease.
The research began in July 2006 and consists of four subprojects:
Collecting Canadian data. The first project assembled and analyzed data on hepatic resection of metastatic colorectal cancer for the past ten years in Canada. The research team now has a picture of the patient population, as well as complications, outcomes, and surgery-related changes over time.
Defining quality care. The second project, currently under way, aims to develop a list of indicators of high-quality care for patients undergoing hepatic resection for metastatic colorectal cancer. It involves a literature review and extensive consultations with a multidisciplinary panel of 16 national experts. (This technique for collecting and distilling knowledge from a group of experts is called a Delphi process.) The team expects to finish this part of the work by the fall of 2007.
Validating quality indicators. Once the list of quality indicators is determined, the third project will commence. It will involve combing through data on patients who have had the surgery in Alberta in the past ten years. The care the patients received will be scored using the quality indicators. Dr. Dixon wants to know whether the scores will correlate with short- and long-term outcomes for these patients.
Assessing the impact of surgeon training. The fourth project will use the Alberta data to investigate whether there is a correlation between patient outcomes and the training of the surgeon who performs the procedure.
"My goal is to improve quality of care," says Dr. Dixon. "To date, we've been pretty good at picking out the things that people are not doing well. I've always wanted to turn that around and focus on the things that are done well. And that's what we're looking at in this research. We're teasing out the best practices of people, institutions, and systems, and then we'll make them available so we can all learn what works best."