Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate?
Background: High quality surgical care for colorectal cancer (CRC) includes obtaining a negative surgical margin. The Michigan Surgical Quality Collaborative (MSQC) is a statewide consortium of hospitals dedicated to quality improvement; a subset of MSQC hospitals abstract quality of care measures f...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
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| Series: | Surgery Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845023000672 |
| _version_ | 1797398551785897984 |
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| author | Lauren Bertoy Calista M. Harbaugh M. Andrew Millis Lucy Zhuo Nicholas Gutsche Graham Beck Kate Panzer Ryan Howard Wenjing Weng Kushal Singh Michael Englesbe Samantha Hendren |
| author_facet | Lauren Bertoy Calista M. Harbaugh M. Andrew Millis Lucy Zhuo Nicholas Gutsche Graham Beck Kate Panzer Ryan Howard Wenjing Weng Kushal Singh Michael Englesbe Samantha Hendren |
| author_sort | Lauren Bertoy |
| collection | DOAJ |
| description | Background: High quality surgical care for colorectal cancer (CRC) includes obtaining a negative surgical margin. The Michigan Surgical Quality Collaborative (MSQC) is a statewide consortium of hospitals dedicated to quality improvement; a subset of MSQC hospitals abstract quality of care measures for CRC surgery, including positive margin rate. The purpose of this study was to determine whether positive margin rates vary significantly by hospital, and whether positive margin rates should be a target for quality improvement. Methods: We performed a retrospective cohort study of patients who underwent CRC resection from 2016 to 2020. The primary outcome was the presence of a positive margin. Univariate and multivariable analyses were performed to test the association of positive margins with patient, hospital, and tumor characteristics. Results: The cohort consisted of 4211 patients from 42 hospitals (85 % colon cancer and 15 % rectal cancer). The crude positive margin rate was 6.15 % (95 % CI 4.6–7.4 %); this ranged from 0 % to 22 % at individual hospitals. In multivariable analysis, factors independently associated with positive margins included male sex, underweight BMI, metastatic cancer, rectal cancer (vs. colon), T4 T-stage, N1c/N2 N-stage, and open surgical approach. After adjusting for these factors, there remained significant variation by hospital, with 8 hospitals being statistically-significant outliers. Conclusions: Positive margins rates for CRC vary by hospital in Michigan, even after rigorous adjustment for case-mix. Furthermore, several hospitals achieved near-zero positive margin rates, suggesting opportunities for quality improvement through the identification of best practices among CRC surgery centers. |
| first_indexed | 2024-03-09T01:27:07Z |
| format | Article |
| id | doaj.art-2f7557f8e0c74ed99c2a788e303d8a96 |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-03-09T01:27:07Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-2f7557f8e0c74ed99c2a788e303d8a962023-12-10T06:17:01ZengElsevierSurgery Open Science2589-84502023-12-01163743Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate?Lauren Bertoy0Calista M. Harbaugh1M. Andrew Millis2Lucy Zhuo3Nicholas Gutsche4Graham Beck5Kate Panzer6Ryan Howard7Wenjing Weng8Kushal Singh9Michael Englesbe10Samantha Hendren11University of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USAMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USAMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USAUniversity of Rochester Medical Center, Department of Surgery, 601 Elmwood Avenue, Rochester, NY 14642, USAUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USAUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USAUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USAMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USAMichigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USAMichigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USAMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA; Michigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USAMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA; Michigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA; Corresponding author at: University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.Background: High quality surgical care for colorectal cancer (CRC) includes obtaining a negative surgical margin. The Michigan Surgical Quality Collaborative (MSQC) is a statewide consortium of hospitals dedicated to quality improvement; a subset of MSQC hospitals abstract quality of care measures for CRC surgery, including positive margin rate. The purpose of this study was to determine whether positive margin rates vary significantly by hospital, and whether positive margin rates should be a target for quality improvement. Methods: We performed a retrospective cohort study of patients who underwent CRC resection from 2016 to 2020. The primary outcome was the presence of a positive margin. Univariate and multivariable analyses were performed to test the association of positive margins with patient, hospital, and tumor characteristics. Results: The cohort consisted of 4211 patients from 42 hospitals (85 % colon cancer and 15 % rectal cancer). The crude positive margin rate was 6.15 % (95 % CI 4.6–7.4 %); this ranged from 0 % to 22 % at individual hospitals. In multivariable analysis, factors independently associated with positive margins included male sex, underweight BMI, metastatic cancer, rectal cancer (vs. colon), T4 T-stage, N1c/N2 N-stage, and open surgical approach. After adjusting for these factors, there remained significant variation by hospital, with 8 hospitals being statistically-significant outliers. Conclusions: Positive margins rates for CRC vary by hospital in Michigan, even after rigorous adjustment for case-mix. Furthermore, several hospitals achieved near-zero positive margin rates, suggesting opportunities for quality improvement through the identification of best practices among CRC surgery centers.http://www.sciencedirect.com/science/article/pii/S2589845023000672Colorectal cancerCancer marginHospital variationQuality of healthcare |
| spellingShingle | Lauren Bertoy Calista M. Harbaugh M. Andrew Millis Lucy Zhuo Nicholas Gutsche Graham Beck Kate Panzer Ryan Howard Wenjing Weng Kushal Singh Michael Englesbe Samantha Hendren Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? Surgery Open Science Colorectal cancer Cancer margin Hospital variation Quality of healthcare |
| title | Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? |
| title_full | Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? |
| title_fullStr | Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? |
| title_full_unstemmed | Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? |
| title_short | Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate? |
| title_sort | positive margin rates for colorectal cancer vary significantly by hospital in michigan can we achieve a 0 positive margin rate |
| topic | Colorectal cancer Cancer margin Hospital variation Quality of healthcare |
| url | http://www.sciencedirect.com/science/article/pii/S2589845023000672 |
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