Authors: Paulson EC, Mitra N, Sonnad S, Armstrong K, Wirtalla C, Kelz RR, Mahmoud NN
Title: National Cancer Institute designation predicts improved outcomes in colorectal cancer surgery.
Journal: Ann Surg 248(4):675-86
Date: 2008 Oct
Abstract: BACKGROUND: Although National Cancer Institute (NCI) designation as a cancer center is based almost solely on research activities, it is often viewed, by patients and referring providers, as an indication of clinical excellence. OBJECTIVE: To compare the short- and long-term outcomes of colon and rectal cancer surgery performed at NCI-designated centers to the outcomes after resection at non-NCI-designated hospitals. METHODS: We performed a retrospective cohort study of Survival, Epidemiology, and End Results (SEER)-Medicare database patients undergoing segmental colectomy (n = 33,969) or proctectomy (n = 8591) for cancer from 1996-2003. Multivariate logistic regression, with and without propensity scores, and matched conditional regression were performed to evaluate the relationship between NCI status and postoperative mortality (in-hospital or 30-day death). The log-rank test, Kaplan-Meier curves, and Cox regression compared survival between hospital types. RESULTS: We evaluated 33,969 colectomy and 8591 proctectomy patients. Postoperative mortality after colectomy was 6.7% at non-NCI and 3.2% at NCI centers. Mortality after proctectomy was 5.0% and 1.9%, respectively. These differences were significant when adjusted for patient and hospital characteristics. For both colon and rectal cancer patients, long-term mortality was significantly improved after resection at NCI centers (HR 0.84, P < 0.001; HR 0.85, P = 0.02, respectively). CONCLUSION: NCI designation is associated with lower risk of postoperative death and improved long-term survival. Possible factors responsible for these benefits include surgeon training, multidisciplinary care, and adherence to treatment guidelines. Studies are underway to elucidate the factors leading to improved patient outcomes.