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

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

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 & Rectum.

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."

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