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Open Access Highly Accessed Research article

The impact of audit and feedback on nodal harvest in colorectal cancer

Geoffrey A Porter12*, Robin Urquhart2, Jingyu Bu23, Paul Johnson1 and Eva Grunfeld45

Author Affiliations

1 Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada

2 Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada

3 Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada

4 Ontario Institute for Cancer Research and Cancer Care Ontario, Toronto, Ontario, Canada

5 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada

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BMC Cancer 2011, 11:2  doi:10.1186/1471-2407-11-2

Published: 3 January 2011



Adequate nodal harvest (≥ 12 lymph nodes) in colorectal cancer has been shown to optimize staging and proposed as a quality indicator of colorectal cancer care. An audit within a single health district in Nova Scotia, Canada presented and published in 2002, revealed that adequate nodal harvest occurred in only 22% of patients. The goal of this current study was to identify factors associated with adequate nodal harvest, and specifically to examine the impact of the audit and feedback strategy on nodal harvest.


This population-based study included all patients undergoing resection for primary colorectal cancer in Nova Scotia, Canada, from 01 January 2001 to 31 December 2005. Linkage of the provincial cancer registry with other databases (hospital discharge, physician claims data, and national census data) provided clinicodemographic, diagnostic, and treatment-event data. Factors associated with adequate nodal harvest were examined using multivariate logistic regression. The specific interaction between year and health district was examined to identify any potential effect of dissemination of the previously-performed audit.


Among the 2,322 patients, the median nodal harvest was 8; overall, 719 (31%) had an adequate nodal harvest. On multivariate analysis, audited health district (p < 0.0001), year (p < 0.0001), younger age (p < 0.0001), non-emergent surgery (p < 0.0001), more advanced stage (p = 0.008), and previous cancer history (p = 0.03) were associated with an increased likelihood of an adequate nodal harvest. Interaction between year and audited health district was identified (p = 0.006) such that the increase in adequate nodal harvest over time was significantly greater in the audited health district.


Improvements in colorectal cancer nodal harvest did occur over time. A published audit demonstrating suboptimal nodal harvest appeared to be an effective knowledge translation tool, though more so for the audited health district, suggesting a potentially beneficial effect of audit and feedback strategies.