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System‐based factors influencing intraoperative decision‐making in rectal cancer by surgeons: an international assessment
Author(s) -
Augestad K. M.,
Lindsetmo R.O.,
Stulberg J. J.,
Reynolds H.,
Champagne B.,
Senagore A. J.,
Delaney C. P.
Publication year - 2012
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2012.03093.x
Subject(s) - medicine , audit , stoma (medicine) , colorectal cancer , multidisciplinary approach , coloanal anastomosis , total mesorectal excision , multidisciplinary team , general surgery , multivariate analysis , surgery , cancer , nursing , management , social science , sociology , economics
Aim Sound surgical judgement is the goal of training and experience; however, system‐based factors may also colour selection of options by a surgeon. We analysed potential organizational characteristics that might influence rectal cancer decision‐making by an experienced surgeon. Method One hundred and seventy‐three international centres 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 analysed using multivariate methods for association with intra‐operative surgical decision‐making. Results The response rate was 71% (123 centres). 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 centres (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. Conclusion 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 that may impact on quality metrics.