Abstracts
1998 Digestive Disease Week

#2335

HOSPITAL PROCEDURE VOLUME AND HOSPITAL TEACHING STATUS DO NOT INFLUENCE OPERATIVE MORTALITY OR LONG-TERM SURVIVAL FOR RECTAL CANCER IN A LARGE GENERAL POPULATION: AN OUTCOMES STUDY. M.Simunovic, E. Sigurdson, T.To, N.Baxter, A.Balshem, Z.Cohen, R.McLeod and E.Ross. Institute for Clinical Evaluative Sciences, Toronto, Ontario. Fox Chase Cancer Center, Philadelphia, PA.

We tested the hypothesis that increased hospital procedure volume and teaching hospital status would improve operative mortality and long-term survival in patients with rectal cancer in Ontario, Canada. All incident cases of colorectal adenocarcinoma, treated within 60 days of diagnosis with abdominoperineal or low-anterior resection, and from years 1988 and 1991 were used. Patient information included age, sex, survival to 1995, and registration at a Regional Cancer Center where all radiotherapy in the province is delivered. Hospitals were stratified by teaching versus non-teaching status, and by volume group - low (_ 10 cases/yr), medium (11-18 cases/yr), high (_ 19 cases/yr). Previous work on a subset of similarly selected patients from 1990 showed no difference in disease stage among volume groups. Logistic regression measured odds ratios (OR) for operative mortality, while proportional hazards calculated risk ratios (RR) for time to failure (death). Models controlled for relevant patient and hospital characteristics. For years 1988 and 1991, respectively, there were 1083 and 1143 cases, percentage teaching hospital status was 30.6% and 28.3% (p=.23), unadjusted operative mortality was 3.32% and 3.76% (p=.58), registration for radiotherapy was 17.2% and 35.9% (p<.01), and distribution by volume group was similar. Likelihood of operative mortality was not significantly influenced by teaching versus nonteaching hospital status (OR=0.7, p=.24), or low- versus high-volume group (OR=0.9, p=.83). Time to death was not significantly influenced by year (RR=1.0, p=.55), teaching versus non-teaching hospital status (RR=0.9, p=.06), or low- versus high-volume group (RR=1.0, p=.90). In conclusion, to improve outcomes for rectal cancer in this large general population, centralization of procedures into fewer higher volume hospitals or teaching hospitals is unlikely to have a major impact, and locally directed initiatives may be necessary such as efforts to improve surgical standards or use of adjuvant therapies.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.