title: Patient survival after surgical treatment of rectal cancer: impact of surgeon and hospital characteristics.
abstract: BACKGROUND
  Surgeon and hospital factors are associated with the survival of patients treated for rectal cancer. The relative contribution of each of these factors toward determining outcomes is poorly understood.
  
  
  METHODS
  We used data from the Surveillance, Epidemiology, and End Results-Medicare database to analyze the outcomes of patients aged 65 years and older undergoing operative treatment for nonmetastatic rectal cancer, diagnosed in the United States between 1998 and 2007. These data were linked to a registry to identify whether the treating surgeon was a board-certified colorectal surgeon versus a noncolorectal surgeon. Hospital volume and hospital certification as a National Cancer Institute-designated Comprehensive Cancer Centers were also analyzed. The primary outcome of interest was long-term survival.
  
  
  RESULTS
  Our data source yielded 6432 patients. Initial analysis demonstrated improved long-term survival in patients treated by higher-volume colorectal surgeons, higher-volume hospitals, teaching hospitals, and National Cancer Institute (NCI)-designated Comprehensive Cancer Centers. Based on an iterative approach to modeling the interactions between these various factors, we found a robust effect of surgeon subspecialty status, hospital volume, and NCI designation. Surgeon volume was not distinctly associated with long-term survival.
  
  
  CONCLUSIONS
  Patients treated for rectal cancer by board-certified colorectal surgeons in centers that are higher volume and/or NCI-designated Comprehensive Cancer Centers experience better overall survival. These differences persist after adjustment for a broad range of patient and contextual risk factors, including surgeon volume. Patients and payers can use these results to identify surgeons and hospitals where outcomes are most favorable.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Phoenix, Arizona; Mayo Clinic Center for the Science of Healthcare Delivery, Rochester, Minnesota.
authors.forename: David A
authors.initials: DA
authors.lastname: Etzioni
authors.forename: Tonia M
authors.initials: TM
authors.lastname: Young-Fadok
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018426:SEER Program; D066231:Surgeons / Q000592:standards* / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
keywords: cancer care facilities; colon and rectal; rectal neoplasms; surgery specialty