Colorectal cancer: Quality of surgical care in Michigan

Am J Surg. 2017 Mar;213(3):548-552. doi: 10.1016/j.amjsurg.2016.11.038. Epub 2016 Nov 27.

Abstract

Objective: Surgery remains the cornerstone therapy for colorectal cancer (CRC). This study assesses CRC quality measures for surgical cases in Michigan.

Methods: In this retrospective cohort study, processes of care and outcomes for CRC resection cases were abstracted in 30 hospitals in the Michigan Surgical Quality Collaborative (2014-2015). Measures were case-mix and reliability adjusted, using logistic regression models.

Results: For 871 cases (640 colon cancer, 231 rectal cancer), adjusted morbidity (27.4%) and mortality rates (1.5%) were low. Adjusted process measures showed gaps in quality of care. Mesorectal excision was documented in 59.4% of rectal cancer (RC) cases, 65% of RC cases had sphincter preserving surgery, 18.7% of cases had < 12 lymph nodes examined, 7.9% had a positive margin, 52.1% of stage II/III RC cases had neoadjuvant therapy, and 36% of ostomy cases had site marking.

Conclusion: This study finds gaps in quality of care measures for CRC, suggesting opportunity for regional quality improvement.

Keywords: Colorectal cancer; Michigan Surgical Quality Collaborative (MSQC); Outcome assessment; Process measures; Quality improvement.

MeSH terms

  • Aged
  • Anal Canal
  • Blood Transfusion / statistics & numerical data
  • Cohort Studies
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery*
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Lymph Nodes / pathology
  • Male
  • Michigan / epidemiology
  • Middle Aged
  • Minimally Invasive Surgical Procedures / statistics & numerical data
  • Neoadjuvant Therapy / statistics & numerical data
  • Organ Sparing Treatments
  • Ostomy
  • Patient Readmission / statistics & numerical data
  • Quality of Health Care*
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology