Quality standard
Quality statement 3: Surgery
Quality statement 3: Surgery
Quality statement
People having surgery for inflammatory bowel disease have it undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Rationale
Better patient outcomes are more likely if surgery for inflammatory bowel disease is undertaken by a colorectal surgeon with expertise and experience in inflammatory bowel disease surgery, with the support of an experienced clinical team. Such expertise is most likely to be in a unit where such surgery is performed regularly. The expertise and experience of the clinical team will enable the best judgement of when to undertake surgery, and should ensure the quality of clinical care before, during and after surgery.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people having surgery for inflammatory bowel disease have it undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Data source: Local data collection. Data on surgery for inflammatory bowel disease are available in the National audit of inflammatory bowel disease (IBD) service provision, section 3, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, section 3.
Process
Proportion of surgical procedures for inflammatory bowel disease undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Numerator – the number in the denominator undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Denominator – the number of surgical procedures for inflammatory bowel disease.
Data source: Local data collection and NHS Digital Hospital episode statistics.
Outcome
Complications after surgery.
Data source: Local data collection. Data on surgical complications are available in the National audit of inflammatory bowel disease (IBD) service provision and the National audit of paediatric inflammatory bowel disease (IBD) service provision, section 3, and the National clinical audit of inpatient care for adults with ulcerative colitis and the National clinical audit of inpatient care for young people with ulcerative colitis, section 4.2.
What the quality statement means for different audiences
Service providers (district general hospitals and specialist tertiary centres) ensure that surgery for inflammatory bowel disease is undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Healthcare professionals undertake inflammatory bowel disease surgery if they are colorectal surgeons with expertise and experience in such surgery, or refer people to a colorectal surgeon with relevant expertise and experience who is a core member of the inflammatory bowel disease multidisciplinary team.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers who can demonstrate that surgery for inflammatory bowel disease is undertaken by colorectal surgeons who are core members of inflammatory bowel disease multidisciplinary teams.
People who have surgery for inflammatory bowel disease have their operation carried out by a specialist surgeon called a colorectal surgeon who is a member of the inflammatory bowel disease care team. This will make it more likely that the operation is a success and ensure good care. Patients should always be involved in the decision to have surgery after a discussion of the benefits and risks.
Source guidance
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British Society of Gastroenterology (BSG). BSG consensus guidelines on the management of inflammatory bowel disease in adults (2019), section 6.1: IBD service and the multidisciplinary team and good practice recommendation 27
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IBD UK. IBD standards (2019), section 5: surgery, statement 5.2: appropriate specialist expertise
Definitions of terms used in this quality statement
Surgery for inflammatory bowel disease
The types of operation performed for inflammatory bowel disease include colectomy, ileo–anal pouch procedure, ileostomy and intestinal resection. [Adapted from NICE's guidelines on Crohn's disease and ulcerative colitis, and the BSG consensus guidelines on the management of inflammatory bowel disease in adults]
Colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team
The surgeon should have expertise and experience in undertaking surgery for inflammatory bowel disease and be able to make informed decisions about the need for surgery and the timing of surgery. Their predominant workload should involve inflammatory bowel disease and they should be a core member of the inflammatory bowel disease multidisciplinary team. Skilled and experienced surgeons, supported by an experienced clinical team, are most likely to be in units where such surgery is performed regularly.
When emergency procedures have to be performed, these may need to be done by a surgeon with the appropriate skills and experience who is available to perform the surgery. Children and young people should have their operations performed by surgeons with expertise in operating on children and young people with inflammatory bowel disease. [Expert opinion and IBD UK's IBD standards, statement 5.1]