Quality of care indicators met at Mount Sinai Hospital during the study period
| Quality of care indicator | Overall % of patients* (no. of patients who met the indicator/total no. of patients) | Period; % of patients* | p value | ||||
|---|---|---|---|---|---|---|---|
| 1997/98, n = 170 | 1999/2000, n = 213 | 2001/02, n = 173 | 2003/04, n = 231 | 2005/06, n = 218 | |||
| Cancers detected by screening | 11.7 (118/1005) | 7.1 | 9.9 | 6.9 | 16 | 16.5 | < 0.001 |
| Adequate evaluation; colonoscopy or barium enema and sigmoidoscopy 3 months before or 6 months after surgery† | 97 (890/918) | 100 | 98 | 96 | 97 | 100 | 0.86 |
| Preoperative screening; liver imaging, all patients | 92 (924/1005) | 89 | 92 | 91 | 92 | 95 | 0.050 |
| Preoperative screening; pelvic imaging, patients with RC | 94 (456/490) | 89 | 94 | 95 | 97 | 95 | 0.040 |
| Consultation with a radiation oncologist; patients with stage II/III RC | 78.7 (174/221) | 73 | 74 | 73 | 81 | 92 | 0.032 |
| Consultation with a medical oncologist; patients with stage II/III RC | 89 (197/221) | 86 | 85 | 90 | 90 | 95 | 0.18 |
| Completeness of the operative report, mean (SD) score | 8.7 (1.4) | 7.9 (1.5) | 8.5 (1.4) | 8.5 (1.4) | 8.9 (1.1) | 9.4 (0.5) | < 0.001 |
| Completeness of the pathology report | |||||||
| Reported the no. of LNs examined‡ | 100 (954/954) | 100 | 100 | 100 | 100 | 100 | 1.00 |
| Reported > 12 LNs examined | 61.2 (584/954) | 49 | 45 | 48 | 69 | 88 | < 0.001 |
| Reported positive LNs | 41.5 (397/954) | 36 | 41 | 46 | 45 | 39 | 0.51 |
| Reported quantitative distal margin measures‡ | 86.5 (825/954) | 82 | 82 | 90 | 88 | 90 | 0.004 |
| Reported quantitative radial margins measures‡ | 73 (679/954) | 52 | 60 | 84 | 83 | 83 | < 0.001 |
| Reported distal margins ≥ 1 cm in patients with RC‡ | 95 (431/455) | 92 | 95 | 92 | 98 | 96 | 0.150 |
| Reported negative radial margins in RC‡ | 87 (391/455) | 94 | 89 | 86 | 81 | 85 | 0.023 |
| Anastomotic leaks in patients with RC§ | 3.7 (11/297) | 9 | 4.7 | 0 | 3.1 | 1.5 | 0.039 |
| In-hospital or 30-day mortality | 2.9 (29/987) | 4.8 | 2.8 | 3.5 | 1.3 | 2.8 | 0.16 |
| Local recurrence | |||||||
| Within 2 years of surgery for RC and colon cancer | 6.5 (50/769) | 9.2 | 6.2 | 3.6 | 7.0 | 0.42 | |
| Following RC | 6.4 (24/377) | 9.1 | 6.6 | 3.6 | 6.3 | 0.52 | |
| Following colon cancer | 6.6 (26/392) | 9.3 | 5.8 | 3.5 | 7.7 | 0.81 | |
| Follow-up colonoscopy at 1 year¶ | 68 (410/604) | 60 | 58 | 66 | 78 | 79 | < 0.001 |
LN = lymph node; NS = not significant; RC = rectal cancer; SD = standard deviation.
↵* Unless otherwise indicated.
↵† First surgery and nonemergent surgeries.
↵‡ We excluded nonresective procedures.
↵§ We excluded patients who underwent nonresective procedures and those who received end stomas.
↵¶ We excluded patients who underwent bypass procedures or total proctocolectomy, those who died within 1 year after surgery, those with stage IV cancer and those aged > 85 years.