Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival

Background Previous studies have suggested that, following surgery for colo rectal cancer, there are significant differences in outcome amongst surgeon s. Methods The following measures of outcome in 1128 patients undergoing surge ry for colorectal cancer were analysed on an individual surgeon basis: post operative complications, postoperative mortality, local recurrence rates, s urvival and hazard ratios. Results The proportion of patients undergoing apparently curative resection varied among surgeons from 39% to 65%; overall postoperative mortality var ied from 8% to 26%. After curative resection the anastomotic leak rate vari ed from 0% to 29%, postoperative mortality from 0% to 14% and local recurre nce within 2 years from 5% to 26%. Survival at 5 years following curative r esection varied from 22% to 61%; survival following palliative resection va ried from 7% to 31% at 2 years. The hazard ratios for mortality, taking int o account the identified risk factors, varied among individual surgeons fro m 0.54 to 1.79, from 0.39 to 1.57 and from 0.66 to 1.19 for curative resect ion, palliative resection and all cases respectively. Conclusion There mere significant surgeon-related variations in patient out come; these variations in outcome need to be addressed if survival followin g colorectal cancer surgery is to improve.