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140. A Dedicated Colorectal Cancer Center in a VA Medical Center Provides Higher Quality of Care for Colorectal Cancer Patients
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
these outcomes. Conclusions: In order to optimize outcomes, patients with thyroid and parathyroid disease should be referred to surgeons based on their thyroidectomy/parathyroidectomy volumes, as high surgeon volume was independently associated with fewer complications, lower LOS and costs. Surgeon specialty might be a consideration, but differences in complication rates based on specialty are significant only among low-, but not high-volume surgeons. Additional data are needed. 140. A DEDICATED COLORECTAL CANCER CENTER IN A VA MEDICAL CENTER PROVIDES HIGHER QUALITY OF CARE FOR COLORECTAL CANCER PATIENTS. J. A. Wilks, C. Liebig, S. H. Tasleem, K. Haderxhanaj, S. Awad, D. H. Berger, D. Albo; Baylor College of Medicine, Houston, TX Introduction: Colorectal cancer is the second leading cause of cancer deaths in the US. In 2006, a dedicated colorectal cancer center (CRCC) was created in a Veterans Affairs medical center in order to improve the care of our colorectal cancer patients. We hypothesized that with the creation of the CRCC, VA colorectal cancer patients would experience higher quality care and increased involvement in multidisciplinary treatment. Methods: A retrospective clinical database (n⫽346) from a six-year period prior to the creation of the colorectal cancer center and a prospective database (n⫽194) created for the three years since the inception of the CRCC were created. All consecutive CRC patients requiring surgical intervention for colorectal cancer were entered into each database. Surrogate quality of care markers analyzed were: percentage of margin-negative resections, number of lymph nodes obtained, delivery of neo-adjuvant therapy and postoperative chemotherapy when indicated. Statistical analyses included Fisher’s exact test, Chi-square test, and unpaired t-test. Results: The overall quality of care of colorectal cancer patients has improved as evidenced by a larger percentage of complete, margin negative resections (Figure 1, p ⬍ 0.001) as well as an increase in number of lymph nodes excised at operation (Figure 2, p ⬍ 0.0001). This has been achieved despite a significant increase in the average annual case volume (45 to 63 per year). Furthermore, of 22 stage III and IV colon cancer patients, only 1 patient did not receive adjuvant therapy compared to 32 of 81 eligible patients prior to creation of the CRC. Nearly all (41/43) eligible rectal cancer patients received neoadjuvant therapy compared to 15 out of 50 (p ⬍ 0.0001) eligible patients from the retrospective study period. Conclusion: A dedicated colorectal cancer center in a VA medical center can significantly improved quality of care for colorectal cancer patients.
141. COMMON GROUND: INTRA-INSTITUTIONAL CORRELATIONS OF MORTALITY RATES AMONG HIGH-RISK PEDIATRIC SURGICAL SPECIALTIES. K. A. Caddell1, B. Diggs2, D. de la Cruz1, W. Walker1, E. Ehieli3, T. Karamlou4, R. M. Ungerleider5, K. F. Welke5; 1Oregon Health & Science University School of Medicine, Portland, OR; 2Oregon Health & Science University, Department of Surgery, Portland, OR; 3Jefferson Medical College, Philadelphia, PA; 4University of Michigan, Department of Cardiovascular Surgery, Ann Arbor, MI; 5 Oregon Health & Science University, Department of Cardiothoracic Surgery, Portland, OR Background: Mortality is the primary measure used to evaluate surgical care. Unfortunately, differentiation of hospital mortality rates for high-risk surgical procedures in the pediatric population is often limited by small procedure-specific sample sizes. While it has been shown that statistical power can be improved by combining data from multiple operations, this approach is only valuable when performance among the procedures is correlated. We sought to determine the utility of such a strategy in the pediatric surgical arena by calculating the correlations between hospital mortality rates for pediatric surgical specialties. Methods: We studied 75 consensusdetermined high-risk operations (mortality ⬎1.5%) performed on patients ⬍⫽ 10 years of age (43,041 cases from 101 hospitals). Data were obtained from the 2003 and 2006 Kids’ Inpatient Databases. Operations were grouped into three categories: neurosurgery, cardiac surgery and general surgery. For each category, we calculated 1) the hospital-level risk-adjusted mortality rate of the category (“categorical mortality”) and 2) the hospital-level risk-adjusted combined mortality rate of the other two categories (“other mortality”). To determine the strength of associations between categorical mortality rates and other mortality, we calculated the correlation coefficients for each pairing. A higher coefficient implies a stronger association. We then divided the selected hospitals into quintiles based on t-statistics of excess other mortality and estimated the risk-adjusted categorical mortality rate for each quintile, thus determining if categorical mortality is associated with other mortality. Results: Categorical mortality was modestly correlated with other mortality for each of the categories (correlation coefficients: general surgery and other mortality: 0.25 (p⫽0.01), cardiac surgery and other mortality: 0.24 (p⫽0.02), and neurosurgery and other mortality: 0.23 (p⫽0.02)). Despite moderate correlations, quintile analysis showed other mortality to be a good predictor of categorical mortality for all three categories. Cardiac surgery had the strongest relationship, with categorical mortality rates at hospitals in the worst quintile of other mortality 1.8 times higher than those in the best quintile (12.2% vs.
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
these outcomes. Conclusions: In order to optimize outcomes, patients with thyroid and parathyroid disease should be referred to surgeons based on their thyroidectomy/parathyroidectomy volumes, as high surgeon volume was independently associated with fewer complications, lower LOS and costs. Surgeon specialty might be a consideration, but differences in complication rates based on specialty are significant only among low-, but not high-volume surgeons. Additional data are needed. 140. A DEDICATED COLORECTAL CANCER CENTER IN A VA MEDICAL CENTER PROVIDES HIGHER QUALITY OF CARE FOR COLORECTAL CANCER PATIENTS. J. A. Wilks, C. Liebig, S. H. Tasleem, K. Haderxhanaj, S. Awad, D. H. Berger, D. Albo; Baylor College of Medicine, Houston, TX Introduction: Colorectal cancer is the second leading cause of cancer deaths in the US. In 2006, a dedicated colorectal cancer center (CRCC) was created in a Veterans Affairs medical center in order to improve the care of our colorectal cancer patients. We hypothesized that with the creation of the CRCC, VA colorectal cancer patients would experience higher quality care and increased involvement in multidisciplinary treatment. Methods: A retrospective clinical database (n⫽346) from a six-year period prior to the creation of the colorectal cancer center and a prospective database (n⫽194) created for the three years since the inception of the CRCC were created. All consecutive CRC patients requiring surgical intervention for colorectal cancer were entered into each database. Surrogate quality of care markers analyzed were: percentage of margin-negative resections, number of lymph nodes obtained, delivery of neo-adjuvant therapy and postoperative chemotherapy when indicated. Statistical analyses included Fisher’s exact test, Chi-square test, and unpaired t-test. Results: The overall quality of care of colorectal cancer patients has improved as evidenced by a larger percentage of complete, margin negative resections (Figure 1, p ⬍ 0.001) as well as an increase in number of lymph nodes excised at operation (Figure 2, p ⬍ 0.0001). This has been achieved despite a significant increase in the average annual case volume (45 to 63 per year). Furthermore, of 22 stage III and IV colon cancer patients, only 1 patient did not receive adjuvant therapy compared to 32 of 81 eligible patients prior to creation of the CRC. Nearly all (41/43) eligible rectal cancer patients received neoadjuvant therapy compared to 15 out of 50 (p ⬍ 0.0001) eligible patients from the retrospective study period. Conclusion: A dedicated colorectal cancer center in a VA medical center can significantly improved quality of care for colorectal cancer patients.
141. COMMON GROUND: INTRA-INSTITUTIONAL CORRELATIONS OF MORTALITY RATES AMONG HIGH-RISK PEDIATRIC SURGICAL SPECIALTIES. K. A. Caddell1, B. Diggs2, D. de la Cruz1, W. Walker1, E. Ehieli3, T. Karamlou4, R. M. Ungerleider5, K. F. Welke5; 1Oregon Health & Science University School of Medicine, Portland, OR; 2Oregon Health & Science University, Department of Surgery, Portland, OR; 3Jefferson Medical College, Philadelphia, PA; 4University of Michigan, Department of Cardiovascular Surgery, Ann Arbor, MI; 5 Oregon Health & Science University, Department of Cardiothoracic Surgery, Portland, OR Background: Mortality is the primary measure used to evaluate surgical care. Unfortunately, differentiation of hospital mortality rates for high-risk surgical procedures in the pediatric population is often limited by small procedure-specific sample sizes. While it has been shown that statistical power can be improved by combining data from multiple operations, this approach is only valuable when performance among the procedures is correlated. We sought to determine the utility of such a strategy in the pediatric surgical arena by calculating the correlations between hospital mortality rates for pediatric surgical specialties. Methods: We studied 75 consensusdetermined high-risk operations (mortality ⬎1.5%) performed on patients ⬍⫽ 10 years of age (43,041 cases from 101 hospitals). Data were obtained from the 2003 and 2006 Kids’ Inpatient Databases. Operations were grouped into three categories: neurosurgery, cardiac surgery and general surgery. For each category, we calculated 1) the hospital-level risk-adjusted mortality rate of the category (“categorical mortality”) and 2) the hospital-level risk-adjusted combined mortality rate of the other two categories (“other mortality”). To determine the strength of associations between categorical mortality rates and other mortality, we calculated the correlation coefficients for each pairing. A higher coefficient implies a stronger association. We then divided the selected hospitals into quintiles based on t-statistics of excess other mortality and estimated the risk-adjusted categorical mortality rate for each quintile, thus determining if categorical mortality is associated with other mortality. Results: Categorical mortality was modestly correlated with other mortality for each of the categories (correlation coefficients: general surgery and other mortality: 0.25 (p⫽0.01), cardiac surgery and other mortality: 0.24 (p⫽0.02), and neurosurgery and other mortality: 0.23 (p⫽0.02)). Despite moderate correlations, quintile analysis showed other mortality to be a good predictor of categorical mortality for all three categories. Cardiac surgery had the strongest relationship, with categorical mortality rates at hospitals in the worst quintile of other mortality 1.8 times higher than those in the best quintile (12.2% vs.