title: Quality of care in rectal cancer surgery. Exploring influencing factors in the West of Scotland.
abstract: OBJECTIVE
  To assess variability in the proportions of types of major resection for rectal cancer throughout the west of Scotland (WoS) and ascertain factors explaining the variability.
  
  
  METHODS
  Retrospective cohort study of a regional population clinical audit database. This was linked to cancer registrations and death certificates in order that outcome analyses could be derived. Univariate and multivariate binary logistic regression analyses were used to explore determinants of survival.
  
  
  RESULTS
  A total of 1574 patients met the inclusion criteria. The age range was from 22 to 97 years. The mean age was 67, median age 68 and the standard deviation was 11.5. The majority of patients (61%) were male. Unlike previous series, male patients and those with poorer socioeconomic circumstances (SEC) were no more likely to receive an abdominoperineal excision (APE) procedure for rectal cancer.
  
  
  CONCLUSIONS
  Variation exists in the west of Scotland regarding surgical treatment for rectal cancer. We found no difference in the type of procedure offered according to sex, intent of operation or socioeconomic circumstances with reference to APE and anterior resection (AR) for rectal cancer. We conclude therefore that our region provides an equitable service on grounds of sex and SEC. This demonstrates that an equitable surgical service has been provided for those suffering from rectal cancer. Circumferential margin positivity was four times more likely in an APE than an AR for rectal cancer. This is not explained by age, stage, sex, socioeconomic circumstances (SEC), volume of surgery, intent of operation, type of admission or year of incidence.
authors.affiliation: Department of Academic Surgery, University of Glasgow, Glasgow, UK. garynicholson@nhs.net
authors.forename: G A
authors.initials: GA
authors.lastname: Nicholson
authors.forename: D S
authors.initials: DS
authors.lastname: Morrison
authors.forename: I G
authors.initials: IG
authors.lastname: Finlay
authors.forename: R H
authors.initials: RH
authors.lastname: Diament
authors.forename: P G
authors.initials: PG
authors.lastname: Horgan
authors.forename: R G
authors.initials: RG
authors.lastname: Molloy
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D010502:Perineum / Q000601:surgery; D011787:Quality of Health Care; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012606:Scotland; D012959:Socioeconomic Factors; D055815:Young Adult