So what is our true stoma rate?

Background NBOCAP September 2012 –1/8/2008 – 31/7/2012 –71% permanent stoma rate –National mean 57.1% Source –HES data

NBOCAP validation Final_cancer_site is derived from ICD10_major_site code in conjunction with primary_procedure_name, teletherapy_type_given and pat_proc_result_t_mri_scan_1

NBOCAP validation Note that the permanent stoma rate is estimated as follows: A patient is assumed to have had a stoma if: –coded as having a stoma (temporary or permanent) in the Audit – OR coded as having a stoma in HES – OR procedure (from Audit where recorded, otherwise from HES) is APER or Hartmann's

A stoma is assumed to have been reversed only if: – procedure (from Audit where recorded, otherwise from HES) was NOT an APER – AND stoma reversal is coded in HES between day of surgery and 12 months from surgery

Source Northumbria Healthcare All cancer operations April 2010 to September 2011 Source –SIRIS –Pathology –(notes) –Amalgamated into separate database

Rectal cancer resections 81 resections –8 (9/9%) no stoma –71 (87.7%) primary stoma –2 (2.5%) secondary stoma

Primary stoma N = 71 –42 (59%) temporary intent –27 (38%) permanent intent –2 (3%) uncertain intent

Secondary stoma N = 2 –Uncertain intent

Stoma closure Reversed N = 33 –33/42 (79%) temporary intent –0/4 uncertain intent Not reversed N=40 –9/42 (21%) temporary intent –4/4 uncertain intent

Overall No stoma 41/81 (51%) Stoma 40/81 (49%) Temporary intent not closed –3 leaks –3 metastases –2 strictures –1 death

Conclusions Difficult to analyse data without independent database HES data may be misleading Need clinician ownership of HES data Who enters data into Somerset? We need to understand how the data will be analysed to enter it correctly