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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 2/2005

01-02-2005 | Original Contributions

Relationship Between Surgeon Caseload and Sphincter Preservation in Patients With Rectal Cancer

Authors: Harriett Purves, M.P.H., Ricardo Pietrobon, M.D., Ph.D., Sheleika Hervey, M.D., Ulrich Guller, M.D., M.H.S., William Miller, M.D., Ph.D., Kirk Ludwig, M.D.

Published in: Diseases of the Colon & Rectum | Issue 2/2005

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PURPOSE

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 (≥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).

CONCLUSION

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.
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Metadata
Title
Relationship Between Surgeon Caseload and Sphincter Preservation in Patients With Rectal Cancer
Authors
Harriett Purves, M.P.H.
Ricardo Pietrobon, M.D., Ph.D.
Sheleika Hervey, M.D.
Ulrich Guller, M.D., M.H.S.
William Miller, M.D., Ph.D.
Kirk Ludwig, M.D.
Publication date
01-02-2005
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 2/2005
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-004-0793-7

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