Effect of academic status on outcomes of surgery for rectal cancer
The purpose of our study was to investigate surgical outcomes following advanced colorectal procedures at academic versus community institutions.
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.
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.
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.
KeywordsColorectal surgery Academic status Surgical outcomes
We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.
All authors contributed substantially in the creation of this manuscript.
Compliance with ethical standards
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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