Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival

Background Previous studies have suggested that, following surgery for colorectal cancer, there are significant differences in outcome amongst surgeons.

Methods The following measures of outcome in 1128 patients undergoing surgery for colorectal cancer were analysed on an individual surgeon basis: postoperative complications, postoperative mortality, local recurrence rates, survival and hazard ratios.

Results The proportion of patients undergoing apparently curative resection varied among surgeons from 39% to 65%; overall postoperative mortality varied from 8% to 26%. After curative resection the anastomotic leak rate varied from 0% to 29%, postoperative mortality from 0% to 14% and local recurrence within 2 years from 5% to 26%. Survival at 5 years following curative resection varied from 22% to 61%; survival following palliative resection varied from 7% to 31% at 2 years. The hazard ratios for mortality, taking into account the identified risk factors, varied among individual surgeons from 0.54 to 1.79, from 0.39 to 1.57 and from 0.66 to 1.19 for curative resection, palliative resection and all cases respectively.

Conclusion There mere significant surgeon-related variations in patient outcome; these variations in outcome need to be addressed if survival following colorectal cancer surgery is to improve.