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Association of National Accreditation Program for Rectal Cancer Accreditation with Outcomes after Rectal Cancer Surgery.
Harbaugh, Calista M; Kunnath, Nicholas J; Suwanabol, Pasithorn A; Dimick, Justin B; Hendren, Samantha K; Ibrahim, Andrew M.
Afiliación
  • Harbaugh CM; From the Department of Surgery, University of Michigan, Ann Arbor, MI (Harbaugh, Suwanabol, Dimick, Hendren, Ibrahim).
  • Kunnath NJ; Center for Healthcare Outcomes and Policy, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, MI (Harbaugh, Kunnath, Suwanabol, Dimick, Hendren, Ibrahim).
  • Suwanabol PA; Center for Healthcare Outcomes and Policy, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, MI (Harbaugh, Kunnath, Suwanabol, Dimick, Hendren, Ibrahim).
  • Dimick JB; From the Department of Surgery, University of Michigan, Ann Arbor, MI (Harbaugh, Suwanabol, Dimick, Hendren, Ibrahim).
  • Hendren SK; Center for Healthcare Outcomes and Policy, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, MI (Harbaugh, Kunnath, Suwanabol, Dimick, Hendren, Ibrahim).
  • Ibrahim AM; From the Department of Surgery, University of Michigan, Ann Arbor, MI (Harbaugh, Suwanabol, Dimick, Hendren, Ibrahim).
J Am Coll Surg ; 239(2): 98-105, 2024 Aug 01.
Article en En | MEDLINE | ID: mdl-38546122
ABSTRACT

BACKGROUND:

The National Accreditation Program for Rectal Cancer (NAPRC) defined a set of standards in 2017 centered on multidisciplinary program structure, evidence-based care processes, and internal audit to address widely variable rectal cancer practices and outcomes across US hospitals. There have been no studies to-date testing the association between NAPRC accreditation and rectal cancer outcomes. STUDY

DESIGN:

This was a retrospective, observational study of Medicare beneficiaries aged 65 to 99 years with rectal cancer who underwent proctectomy from 2017 to 2020. The primary exposure was NAPRC accreditation and the primary outcomes included mortality (in-hospital, 30 day, and 1 year) and 30-day complications, readmissions, and reoperations. Associations between NAPRC accreditation and each outcome were tested using multivariable logistic regression with risk-adjustment for patient and hospital characteristics.

RESULTS:

Among 1,985 hospitals, 65 were NAPRC-accredited (3.3%). Accredited hospitals were more likely to be nonprofit and teaching with 250 or more beds. Among 20,202 patients, 2,078 patients (10%) underwent proctectomy at an accredited hospital. Patients at accredited hospitals were more likely to have an elective procedure with a minimally invasive approach and sphincter preservation. Risk-adjusted in-hospital mortality (1.1% vs 1.3%; p = 0.002), 30-day mortality (2.1% vs 2.9%; p < 0.001), 30-day complication (18.3% vs 19.4%; p = 0.01), and 1-year mortality rates (11% vs 12.1%; p < 0.001) were significantly lower at accredited compared with nonaccredited hospitals.

CONCLUSIONS:

NAPRC-accredited hospitals have lower risk-adjusted morbidity and mortality for major rectal cancer surgery. Although NAPRC standards address variability in practice, without directly addressing surgical safety, our findings suggest that NAPRC-accredited hospitals may provide higher quality surgical care.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias del Recto / Proctectomía / Acreditación Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Surg Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias del Recto / Proctectomía / Acreditación Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Surg Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos