title: Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population.
abstract: A clear benefit of increased hospital procedure volume or teaching hospital status on outcomes of rectal cancer surgery has yet to be shown. Few have examined treatment differences that may lead to varying outcomes. This study assessed the impact of hospital procedure volume and teaching status on both treatment and outcome measures of rectal cancer surgery in a large general population. Data were obtained for 1072 incident cases of rectal adenocarcinoma diagnosed in 1990 from Ontario, Canada, and treated with a major resection. Hospitals were classified by teaching status and procedure volume. Pathology reports were examined for 418 procedures. Abdominoperineal resections accounted for 31.0% of all procedures. There were no clinically significant differences in treatment measures, operative mortality, and long-term survival among the hospital groups according to both univariate and multivariate analyses. In conclusion, the absence of a hospital volume or teaching status effect on treatment and outcome measures suggests that for rectal cancer surgery in Ontario, centralization of procedures into high-volume or teaching centers is unlikely to improve surgical quality.
authors.affiliation: Fox Chase Cancer Center Outcomes Group, Philadelphia, PA 19111, USA. m_simunovic@fccc.edu
authors.forename: M
authors.initials: M
authors.lastname: Simunovic
authors.forename: T
authors.initials: T
authors.lastname: To
authors.forename: N
authors.initials: N
authors.lastname: Baxter
authors.forename: A
authors.initials: A
authors.lastname: Balshem
authors.forename: E
authors.initials: E
authors.lastname: Ross
authors.forename: Z
authors.initials: Z
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: McLeod
authors.forename: P
authors.initials: P
authors.lastname: Engstrom
authors.forename: E
authors.initials: E
authors.lastname: Sigurdson
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D003625:Data Collection; D013505:Digestive System Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome