28 July 2023 (Last updated 28 Jul 2023)

Dear ACPGBI Members,

An important NCEPOD report on Crohn’s Disease surgery has been released this week: "Making the Cut: Improving the Quality of Colorectal Surgery for Crohn's Disease in the UK". The full report, along with a summary of recommendations, checklist and infographics can be accessed here.

The report identified significant variation in the quality of colorectal surgery for Crohn's disease in the UK. A number of potential causative factors were proposed, including the lack of national standards for the care of people with Crohn's disease, the lack of training for surgeons in the management of Crohn's disease, and the lack of coordination between different specialities.

“Surgery for patients with drug resistant Crohn’s disease surgery should be considered earlier in the treatment pathway for patients, instead of surgery being perceived as a failure of medical care. Once a decision to perform surgery has been made it should be undertaken within a month to prevent patients on elective waiting lists deteriorating and requiring emergency surgery. Furthermore, closer working between all members of the multidisciplinary team would benefit patients, to reduce delays as well as providing all the holistic care that patients with Crohn’s disease need.”

The report recommendations included:

• Improving coordination between the wider inflammatory bowel disease team; colorectal surgeons, gastroenterologists, specialist nurses, stoma therapists, psychologists, pharmacists, and dieticians.
• Ensuring careful medication management throughout the treatment pathway
• Considering surgery as a potential treatment, rather than failure of medical management
• Performing surgery promptly, with pre-operative optimisation, aiming to avoid emergency surgery
• Investigating, and take appropriate action as necessary (e.g. report as a serious incident), when a patient with Crohn’s disease on an elective urgery waiting list undergoes emergency surgery for a complication of their Crohn’s disease.
• Ensuring close handover between the wider IBD team

We believe that the recommendations in the NCEPOD report are essential to improving the quality of surgery for Crohn's disease in the UK. We urge you to read the report and take a critical look at the recommendations to assess if your local service is running optimally. You may be able to use this document to drive up the quality of your service, for example to underpin bids to provide adequate access to radiology, psychology or admin support and thereby enable true multidisciplinary care for IBD patients under your care.

Alongside this, ACPGBI will continue to champion the report and aim to help ensure these recommendations are implemented at all units performing surgery for Crohn’s Disease, for the benefit of all our patients.

Prof Tom Pinkney, Chair IBD Sub-Committee ACPGBI

Miss Katie Adams, Chair External Affairs Committee ACPGBI

Prof Jared Torkington, President ACPGBI

ACCESS THE FULL RESPONSE FROM ACPGBI >

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The NCEPOD report highlights the quality of care provided to patients aged 16 and over with a diagnosis of, and who underwent surgery for, Crohn’s disease.

A report published by the National Confidential Enquiry into Patient Outcome and Death (2023)  The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is an independent body to which a corporate commitment has been made by the medical and surgical royal colleges, associations and faculties related to its area of activity. 

ACCESS THE REPORT >

 

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