The mortality for patients who had colorectal surgery performed
by board-certified colon and rectal surgeons over an 8-year period
(1986-1994) was 1.4%, as compared with 7.3% for a similar group
of patients operated on by other surgeons, according to a study
published in the February issue of Diseases of the Colon &
The study by Lester Rosen, md, John J. Stasik, Jr., md, and others
at the Lehigh Valley Hospital, Allentown, Pennsylvania, covered
2,805 patients treated by 39 surgeons. Of the 39 surgeons, 6 were
board-certified colon and rectal specialists. They performed 56%
of the surgeries.
Beginning in 1989, all hospitalized patients were assigned to
an admission severity group (ASG) from 0 (minimal or no risk of
vital organ failure or medical instability with a very low risk
of death) to 4 (vital organ failure and medical instability with
a much greater risk of death). The ASG ranking is part of a system
for analysis of clinical information used by the Pennsylvania
Health Care Cost Containment Council, an agency established by
the state legislature to address problems of escalating health
costs, to insure the quality of health care, and to increase access
to health-care services for all citizens.
A review of the files of 1,753 patients for whom ASG data were
available showed that surgery performed by board-certified colorectal
surgeons had a mortality of 0.8% for the sicker patients in ASG
2, compared to 3.8% for other surgeons, and 5.7% in ASG 3, compared
to 16.4% for nonspecialists.
Colorectal specialists were also able to release patients in ASG
2 and ASG 3 from the hospital sooner than other surgeons, according
to the study. ASG 2 patients treated by colorectal specialists
spent an average of 12.3 days in the hospital, compared to 16.1
days for other surgeons' patients. In ASG 3 patients, the difference
was 17.0 vs 21.2 days.
"Managed care and state and federal organizations are focusing
on comparative outcomes with increasingly sophisticated data retrieval
and analysis systems to ensure validity," the study concludes.
"Changes in delivery of health care (ie, despecialization)
based on these systems are controversial. Despecialization of
surgical care, particularly for high-risk patients, is unacceptable
if superior quality is demonstrated by legislated outcome databases."