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Effect of academic status on outcomes of surgery for rectal cancer

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Abstract

Background

The purpose of our study was to investigate surgical outcomes following advanced colorectal procedures at academic versus community institutions.

Methods

The SPARCS database was used to identify patients undergoing Abdominoperineal resection (APR) and Low Anterior Resection between 2009 and 2014. Linear mixed models and generalized linear mixed models were used to compare outcomes. Laparoscopic versus open procedures, surgery type, volume status, and stoma formation between academic and community facilities were compared.

Results

Higher percentages of laparoscopic surgeries (58.68 vs. 41.32%, p value < 0.0001), more APR surgeries (64.60 vs. 35.40%, p value < 0.0001), more high volume hospitals (69.46 vs. 30.54%, p value < 0.0001), and less stoma formation (48.00 vs. 52.00%, p value < 0.0001) were associated with academic centers. After adjusting for confounding factors, academic facilities were more likely to perform APR surgeries (OR 1.35, 95% CI 1.04–1.74, p value = 0.0235). Minorities and Medicaid patients were more likely to receive care at an academic facility. Stoma formation, open surgery, and APR were associated with longer LOS and higher rate of ED visit and 30-day readmission.

Conclusion

Laparoscopy and APR are more commonly performed at academic than community facilities. Age, sex, race, and socioeconomic status affect the facility at which and the type of surgery patients receive, thereby influencing surgical outcomes.

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Acknowledgements

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

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Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA

    Kristen Cagino, Maria S. Altieri, Mark Talamini, Konstantinos Spaniolas & Aurora Pryor

  2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Lizhou Nie

  4. Division of Colon and Rectal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA

    Paula Denoya

Authors
  1. Kristen Cagino
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  2. Maria S. Altieri
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  3. Jie Yang
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  4. Lizhou Nie
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  5. Mark Talamini
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  6. Konstantinos Spaniolas
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  7. Paula Denoya
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  8. Aurora Pryor
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Contributions

All authors contributed substantially in the creation of this manuscript.

Corresponding author

Correspondence to Kristen Cagino.

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Disclosures

Dr. Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore and is a consultant for the Medicines Company, Merck, and Intuitive. Ms. Cagino, Mr. Nie, Drs. Altieri, Yang, Talamini and Spaniolas have no conflicts of interest or financial ties to disclose.

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Cagino, K., Altieri, M.S., Yang, J. et al. Effect of academic status on outcomes of surgery for rectal cancer. Surg Endosc 32, 2774–2780 (2018). https://doi.org/10.1007/s00464-017-5977-z

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  • DOI: https://doi.org/10.1007/s00464-017-5977-z

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