Hospital and surgeon variation in positive circumferential resection margin among rectal cancer patients - 17/10/19
Abstract |
Background |
The objective of this study was to evaluate variation in positive CRM at the surgeon and hospital levels and assess impact on disease-specific survival.
Methods |
Patients with stage I-III rectal cancer were identified in New York State. Bayesian hierarchical regressions estimated observed-to-expected (O/E) ratios for each surgeon/hospital. Competing-risks analyses estimated disease-specific survival among patients who were treated by surgeons/hospitals with O/E > 1 compared to those with O/E ratio ≤ 1.
Results |
Among 1,251 patients, 208 (17%) had a positive CRM. Of the 345 surgeons and 118 hospitals in the study, 99 (29%) and 48 (40%) treated a higher number of patients with CRM than expected, respectively. Patients treated by surgeons with O/E > 1 (HR = 1.38, 95% CI = 1.16, 1.67) and those treated at hospitals with O/E > 1 (HR = 1.44, 95% CI = 1.11, 1.85) had worse disease-specific survival.
Discussion |
Surgeon and hospital performance in positive CRM is associated with worse prognosis suggesting opportunities to enhance referral patterns and standardize care.
Le texte complet de cet article est disponible en PDF.Highlights |
• | After risk adjustment, performance in positive CRM varied widely among surgeons and hospitals in New York State. |
• | Most surgeons with higher than expected positive CRM cases operated at least once at a hospital with higher than expected cases. |
• | Surgeon and hospital perfromance in positive CRM was associated with worse disease-specific survival. |
Keywords : Outcomes research, Rectal neoplasms, Quality of health care, Quality indicators, Health care, Colorectal surgery
Plan
Vol 218 - N° 5
P. 881-886 - novembre 2019 Retour au numéro
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