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

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

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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Authors and Affiliations

  1. Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, North Carolina

    Harriett Purves M.P.H., Ricardo Pietrobon M.D., Ph.D., Sheleika Hervey M.D. & Ulrich Guller M.D., M.H.S.

  2. Division of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina

    Ricardo Pietrobon M.D., Ph.D.

  3. Department of Surgery, Duke University Medical Center, Durham, North Carolina

    Ulrich Guller M.D., M.H.S.

  4. Department of Surgery, Division of General Surgery and Surgery Research, University of Basel, Basel, Switzerland

    Ulrich Guller M.D., M.H.S.  & Kirk Ludwig M.D.

  5. Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina

    William Miller M.D., Ph.D.

Authors
  1. Harriett Purves M.P.H.
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  2. Ricardo Pietrobon M.D., Ph.D.
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  3. Sheleika Hervey M.D.
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  4. Ulrich Guller M.D., M.H.S.
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  5. William Miller M.D., Ph.D.
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  6. Kirk Ludwig M.D.
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Correspondence to Kirk Ludwig M.D..

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Purves, H., Pietrobon, R., Hervey, S. et al. Relationship Between Surgeon Caseload and Sphincter Preservation in Patients With Rectal Cancer. Dis Colon Rectum 48, 195–204 (2005). https://doi.org/10.1007/s10350-004-0793-7

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  • DOI: https://doi.org/10.1007/s10350-004-0793-7

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