Relationship between surgeon caseload and sphincter preservation in patients with rectal cancer.
OBJECTIVE
The aim of this study was to determine by means of a national database whether higher surgeon caseload correlates with greater utilization of sphincter-sparing procedures than of abdominoperineal resections in treatment of patients with rectal cancer.


METHODS
Patients with a primary International Classification of Diseases-9 diagnosis code of rectal cancer who underwent a sphincter-sparing procedure or abdominoperineal resection were selected from the 1997 Nationwide Inpatient Sample, a database that represents 20 percent of all U.S. community hospital discharges. Multivariable logistic regression models were used on a 20 percent sample of this database to estimate the risk-adjusted relationship between surgeon caseload volume and the odds of receiving a sphincter-sparing procedure. All models were adjusted for age, gender, race, hospital region, and patient comorbidity.


RESULTS
The study population (n = 477) was 70.4 percent white and 57.9 percent male with an average age of 67.6 years. The mean Deyo comorbidity score was 7.0. Patients treated by surgeons in the highest-volume category (> or =10 rectal cancer surgeries per year) compared with those treated by surgeons in the lowest-volume category (1-3 rectal cancer surgeries per year) were significantly more likely to undergo a sphincter-sparing procedure, after adjustment for other covariates (odds ratio = 5.05; 95 percent confidence interval, 2.5-10.22).


CONCLUSIONS
This analysis suggests that rectal cancer patients treated by high-volume surgeons are five times more likely to undergo sphincter-sparing procedures than those treated by low-volume surgeon. This has significant implications for those seeking a sphincter-preserving option for the treatment of their rectal cancer.
Purves
Harriett
H
Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC 27710, USA.
Pietrobon
Ricardo
R
Hervey
Sheleika
S
Guller
Ulrich
U
Miller
William
W
Ludwig
Kirk
K
D002983:Clinical Competence; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012004:Rectal Neoplasms / Q000601:surgery*; D014481:United States