System-based factors influencing intraoperative decision-making in rectal cancer by surgeons. An international assessment
Colorectal Disease, 06/08/2012
Augestad KM et al. – Treatment variance of rectal cancer surgeons appears to be significantly influenced by organizational characteristics and complex team–based decision making. System based factors may need to be considered as a source of outcome variation which may impact on quality metrics.Methods
- 173 international centers treating rectal cancer were invited to participate in a survey assessment of key treatment options for patients undergoing curative rectal cancer surgery.
- The key organizational characteristics were analyzed by multivariate methods for association with intraoperative surgical decision-making.
- The response rate was 71% (123 centers).
- Sphincter saving surgery was more likely to be performed at university hospitals (OR=3,63, p=0,01) and by high caseload surgeons (OR=2,77 p=0,05).
- A diverting stoma was performed more frequently in departments with clinical audits (OR=3,06, p=0,02), and a diverting stoma with coloanal anastomosis was more likely in European centers (OR=4,14, p=0,004).
- One stage surgery was less likely where there was assessment by a multidisciplinary team (OR=0,24, p=0,02).
- Multivariate analysis showed that university hospital, clinical audit, European centre, multidisciplinary team, and high caseload significantly impacted on surgical decision-making.