Background: Rates of abdominoperineal resection (APR) have been suggested as a solitary surrogate marker for comparing overall hospital quality in rectal cancer surgery. This study investigated the utility of this marker by examining the associations between hospital APR rates and other quality indicators.

Methods: A linked population-based dataset of 1,703 rectal cancer patients diagnosed in 2007/2008 who received surgery in New South Wales, Australia was used. Hospital-level correlations between risk-adjusted APR rates for low rectal cancer and six risk-adjusted outcomes and six care processes were performed (e.g. 30-day mortality, complications, timely treatment receipt). The ability of APR rates to discriminate between hospitals’ performance was examined through hospital variance results in multilevel regression models and funnel plots.

Results: 15.9% of all rectal cancer patients receiving surgery had an APR (95% CI: 14.2-17.6%). Among 707 people with low rectal cancer, 38.2% had an APR (95% CI: 34.6-41.8%). Although risk-adjusted hospital rates of APR for low rectal cancer varied by up to 100%, only one hospital fell outside funnel plots limits (1.4%) and hospital variance in multilevel models was not markedly large. Lower hospital rates of APR for low rectal cancer were not significantly correlated with better hospital-level outcomes or process measures except for recording of pathological stage (r=-0.55, p=0.019). Interestingly, a patient was significantly more likely to receive an APR for low rectal cancer if they attended a non-tertiary metropolitan hospital (ORadj = 2.1, 95% CI: 1.1-4.1).

Conclusions: APR rates do not appear to be a useful surrogate marker of overall hospital performance in rectal cancer surgery.

This research has been accepted for publication in the British Journal of Surgery.