Hospital variation in sphincter preservation for elderly rectal cancer patients. J Surg Res 2014 Sep;191(1):161-8
Date
04/23/2014Pubmed ID
24750983Pubmed Central ID
PMC4134697DOI
10.1016/j.jss.2014.03.047Scopus ID
2-s2.0-84906227108 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
BACKGROUND: The primary goal of an operation for rectal cancer is to cure cancer and, where possible, preserve continence. A wide range of sphincter preservation rates have been reported. This study evaluated hospital variation in the use of low anterior resection (LAR), local excision (LE), and abdominoperineal resection (APR) in the treatment of elderly rectal cancer patients.
METHODS: Using Surveillance, Epidemiology, and End Results-Medicare linked data, we identified 4959 patients older than 65 y with stage I-III rectal cancer diagnosed from 2000-2005 who underwent operative intervention at one of 370 hospitals. We evaluated the distribution of hospital-specific procedure rates and used generalized mixed models with random hospital effects to examine the influence of patient characteristics and hospital on operation type, using APR as a reference.
RESULTS: The median hospital performed APR on 33% of elderly patients with rectal cancer. Hospital was a stronger predictor of LAR receipt than any patient characteristic, explaining 32% of procedure choice, but not a strong predictor of LE, explaining only 3.8%. Receipt of LE was primarily related to tumor size and tumor stage, which combined explained 31% of procedure variation.
CONCLUSIONS: Receipt of LE is primarily determined by patient characteristics. In contrast, the hospital where surgery is performed significantly influences whether a patient undergoes an LAR or APR. Understanding the factors that cause this institutional variation is crucial to ensuring equitable availability of sphincter preservation.
Author List
Dodgion CM, Neville BA, Lipsitz SR, Schrag D, Breen E, Zinner MJ, Greenberg CCAuthor
Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Anal Canal
Comorbidity
Digestive System Surgical Procedures
Female
Hospitals
Humans
Male
Neoplasm Staging
Organ Sparing Treatments
Perineum
Predictive Value of Tests
Rectal Neoplasms
SEER Program
Socioeconomic Factors
