Variations in colon and rectal surgical mortality. Comparison of specialties with a state-legislated database.
OBJECTIVE
This study was designed to examine variations in operative mortality among surgical specialists who perform colorectal surgery.


METHODS
Mortality rates were compared between six board-certified colorectal surgeons and 33 other institutional surgeons using comparable colorectal procedure codes and a validated database indicating patient severity of illness. Thirty-five ICD-9-CM procedure codes were used to identify 2,805 patients who underwent colorectal surgery as their principal procedure between July 1986 and April 1994. Atlas, a state-legislated outcome database, was used by the hospital's Quality Assurance Department to rank the Admission Severity Group (ASG) of 1,753 patients from January 1989 to April 1994 (higher ASG, 0 to 4, indicates increasing medical instability).


RESULTS
Colorectal surgeons had an eight-year mean in-hospital mortality rate of 1.4 percent compared with 7.3 percent by other institutional surgeons (P = 0.0001). There was a significantly lower mortality rate for colorectal surgeons compared with other institutional surgeons in ASG 2 (0.8 and 3.8 percent, respectively; P = 0.026) and ASG 3 (5.7 and 16.4 percent, respectively; P = 0.001).


CONCLUSIONS
Board-certified colorectal surgeons had a lower in-hospital mortality rate than other institutional surgeons as patients' severity of illness increased.
Rosen
L
L
Division of Colon/Rectal Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
Stasik
J J
JJ
Reed
J F
JF
Olenwine
J A
JA
Aronoff
J S
JS
Sherman
D
D
D003106:Colon / Q000601:surgery*; D016208:Databases, Factual / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D010414:Pennsylvania; D012007:Rectum / Q000601:surgery*; D012720:Severity of Illness Index; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000401:mortality*