title: Colorectal cancer: Quality of surgical care in Michigan.
abstract: OBJECTIVE
  Surgery remains the cornerstone therapy for colorectal cancer (CRC). This study assesses CRC quality measures for surgical cases in Michigan.
  
  
  METHODS
  In this retrospective cohort study, processes of care and outcomes for CRC resection cases were abstracted in 30 hospitals in the Michigan Surgical Quality Collaborative (2014-2015). Measures were case-mix and reliability adjusted, using logistic regression models.
  
  
  RESULTS
  For 871 cases (640 colon cancer, 231 rectal cancer), adjusted morbidity (27.4%) and mortality rates (1.5%) were low. Adjusted process measures showed gaps in quality of care. Mesorectal excision was documented in 59.4% of rectal cancer (RC) cases, 65% of RC cases had sphincter preserving surgery, 18.7% of cases had < 12 lymph nodes examined, 7.9% had a positive margin, 52.1% of stage II/III RC cases had neoadjuvant therapy, and 36% of ostomy cases had site marking.
  
  
  CONCLUSIONS
  This study finds gaps in quality of care measures for CRC, suggesting opportunity for regional quality improvement.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States. Electronic address: akanters@med.umich.edu.
authors.forename: Arielle
authors.initials: A
authors.lastname: Kanters
authors.affiliation: Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mullard
authors.affiliation: Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Arambula
authors.affiliation: Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States.
authors.forename: Laurie
authors.initials: L
authors.lastname: Fasbinder
authors.affiliation: Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States.
authors.forename: Greta
authors.initials: G
authors.lastname: Krapohl
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.affiliation: Michigan Surgical Quality Collaborative, Ann Arbor, MI, United States.
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
mesh_terms: D000368:Aged; D001003:Anal Canal; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D059351:Organ Sparing Treatments; D010030:Ostomy; D010359:Patient Readmission / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Colorectal cancer; Michigan Surgical Quality Collaborative (MSQC); Outcome assessment; Process measures; Quality improvement