Mortality of Colorectal Surgery Much Lower if Performed by Colorectal Specialists, Study Shows

The mortality for patients who had colorectal surgery performedby board-certified colon and rectal surgeons over an 8-year period(1986-1994) was 1.4%, as compared with 7.3% for a similar groupof patients operated on by other surgeons, according to a studypublished in the February issue of Diseases of the Colon &Rectum.

The study by Lester Rosen, md, John J. Stasik, Jr., md, and othersat the Lehigh Valley Hospital, Allentown, Pennsylvania, covered2,805 patients treated by 39 surgeons. Of the 39 surgeons, 6 wereboard-certified colon and rectal specialists. They performed 56%of the surgeries.

Beginning in 1989, all hospitalized patients were assigned toan admission severity group (ASG) from 0 (minimal or no risk ofvital organ failure or medical instability with a very low riskof death) to 4 (vital organ failure and medical instability witha much greater risk of death). The ASG ranking is part of a systemfor analysis of clinical information used by the PennsylvaniaHealth Care Cost Containment Council, an agency established bythe state legislature to address problems of escalating healthcosts, to insure the quality of health care, and to increase accessto health-care services for all citizens.

A review of the files of 1,753 patients for whom ASG data wereavailable showed that surgery performed by board-certified colorectalsurgeons had a mortality of 0.8% for the sicker patients in ASG2, compared to 3.8% for other surgeons, and 5.7% in ASG 3, comparedto 16.4% for nonspecialists.

Colorectal specialists were also able to release patients in ASG2 and ASG 3 from the hospital sooner than other surgeons, accordingto the study. ASG 2 patients treated by colorectal specialistsspent an average of 12.3 days in the hospital, compared to 16.1days for other surgeons' patients. In ASG 3 patients, the differencewas 17.0 vs 21.2 days.

"Managed care and state and federal organizations are focusingon comparative outcomes with increasingly sophisticated data retrievaland analysis systems to ensure validity," the study concludes."Changes in delivery of health care (ie, despecialization)based on these systems are controversial. Despecialization ofsurgical care, particularly for high-risk patients, is unacceptableif superior quality is demonstrated by legislated outcome databases."