Rectal Cancer Surgical Outcomes Improved at Accredited Hospitals

In-hospital mortality and complication rates were lower at accredited hospitals vs those not accredited for patients undergoing rectal cancer surgery.

Hospitals that had American College of Surgeons (ACS) National Accreditation Program for Rectal Cancer (NAPRC) accreditation were found to have lower mortality and complication rates from rectal cancer surgery compared with facilities that did not have accreditation, according to retrospective findings published in the Journal of the American College of Surgeons.¹

Results showed that the rates of in-hospital mortality were 1.1% in accredited hospitals compared with 1.3% in those that are not (P = .002), and 30-day mortality rates were 2.1% vs 2.9% (P <.001). Additionally, 30-day complications were 18.3% in accredited centers vs 19.4% in non-accredited ones (P = .01), and 1-year mortality rates were 11.0% vs 12.1% (P <.001), respectively.

Patients at a NAPRC accredited hospital were more likely to undergo proctectomy compared with a non-accredited hospital (95.4% vs 91.1%; P <.001), a minimally invasive approach (45.9% vs 39.9%; P <.001), or sphincter preservation (79.5% vs 76.5%; P = .002).

The risk-adjusted 30-day mortality rate was 2.4% at accredited hospitals vs 2.9% at non-accredited hospitals (adjusted odds ratio 0.84; 95% CI, 0.80-0.89; P <.001).

“Our findings suggest that adherence to NAPRC standards can significantly improve the outcomes for patients undergoing major rectal cancer surgery,” said lead author of the study, Calista Harbaugh, MD, MSc, assistant professor in the division of colorectal surgery at the University of Michigan, in a press release about the study.² “The accreditation process, while resource-intensive, holds the potential to elevate the standard of care and reduce morbidity and mortality associated with rectal cancer surgery."

ACS-developed NAPRC standards focus on multidisciplinary program structure, evidence-based care processes, and internal auditing dedicated to keeping quality principles for rectal cancer treatment and outcomes. However, 3.3% of included hospitals are accredited and no studies have looked at the link between rectal cancer outcomes and accredited centers. Moreover, 10% of 20,202 patients had a proctectomy at an accredited hospital.

In the trial, investigators analyzed surgical outcomes of patients with rectal cancer who were Medicare beneficiaries and who had a proctectomy between 2017 and 2020. Patients were aged between 65 and 99 years. The primary exposure was NAPRC accreditation, and the coprimary end points were in-hospital, 30-day, and 1-year mortality; and 30-day complications, readmissions, and reoperations. Multivariable logistic regression with risk adjustment for both patient and hospital features was used to measure the link between accreditation and outcomes.

The authors defined in-hospital mortality by the vital status of the patient at the time of discharge. For the 30-day mortality rate, death was defined as occurring before discharge or within 30 days of discharge. The 1-year mortality rate was defined as patient death occurring before or 365 days after hospital discharge. Patients who were readmitted were defined as inpatient admission between 1 and 30 days after hospital discharge from the operation.

Findings of the trial also showed that accredited hospitals are more likely to be teaching, nonprofit centers that can also hold at least 500 beds. The patients who had proctectomy at accredited hospitals were more likely to have elective procedures that were minimally invasive and had sphincter preservation.

The authors noted that the limitations are that the study did not capture hospitals in the process of becoming accredited.

“NAPRC accreditation differs fundamentally from other programs because it prioritizes processes over sheer volume or isolated outcomes,” Harbaugh noted in the press release. “It’s not merely about how many procedures we perform, but how we perform them, integrating multidisciplinary care, rigorous internal audits, and continuous improvement into the fabric of our treatment protocols.”

References

1. Harbaugh CM, Kunnath NJ, Suwanabol PA, Dimick JB, Hendren SK, Ibrahim AM. Association of National Accreditation Program for Rectal Cancer Accreditation with outcomes after rectal cancer surgery. J Amer College Surg. Published March 28, 2024. doi:10.1097/XCS.0000000000001064
2. Study shows improved outcomes in hospitals accredited for rectal cancer surgery. News release. American College of Surgeons. March 28, 2024. Accessed April 5, 2024. https://shorturl.at/alqW1