Evidence map›Paper›PMID 37766798›Full record

ArticleSurgery open science2023

Positive margin rates for colorectal cancer vary significantly by hospital in Michigan: Can we achieve a 0 % positive margin rate?

Lauren Bertoy, Calista M Harbaugh, M Andrew Millis, Lucy Zhuo, Nicholas Gutsche, Graham Beck, Kate Panzer, Ryan Howard, Wenjing Weng, Kushal Singh and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgery open science, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Lauren BertoyUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA.
Calista M HarbaughMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
M Andrew MillisMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
Lucy ZhuoUniversity of Rochester Medical Center, Department of Surgery, 601 Elmwood Avenue, Rochester, NY 14642, USA.
Nicholas GutscheUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA.
Graham BeckUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA.
Kate PanzerUniversity of Michigan, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA.
Ryan HowardMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
Wenjing WengMichigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA.
Kushal SinghMichigan Medicine, Michigan Surgical Quality Collaborative, 4251 Plymouth Road, Ann Arbor, MI 48105, USA.
Michael EnglesbeMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
Samantha HendrenMichigan Medicine, Department of Surgery, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: High quality surgical care for colorectal cancer (CRC) includes obtaining a negative surgical margin. The Michigan Surgical Quality Collaborative (MSQC) is a statewide consortium of hospitals dedicated to quality improvement; a subset of MSQC hospitals abstract quality of care measures for CRC surgery, including positive margin rate. The purpose of this study was to determine whether positive margin rates vary significantly by hospital, and whether positive margin rates should be a target for quality improvement. Methods: We performed a retrospective cohort study of patients who underwent CRC resection from 2016 to 2020. The primary outcome was the presence of a positive margin. Univariate and multivariable analyses were performed to test the association of positive margins with patient, hospital, and tumor characteristics. Results: The cohort consisted of 4211 patients from 42 hospitals (85 % colon cancer and 15 % rectal cancer). The crude positive margin rate was 6.15 % (95 % CI 4.6-7.4 %); this ranged from 0 % to 22 % at individual hospitals. In multivariable analysis, factors independently associated with positive margins included male sex, underweight BMI, metastatic cancer, rectal cancer (vs. colon), T4 T-stage, N1c/N2 N-stage, and open surgical approach. After adjusting for these factors, there remained significant variation by hospital, with 8 hospitals being statistically-significant outliers. Conclusions: Positive margins rates for CRC vary by hospital in Michigan, even after rigorous adjustment for case-mix. Furthermore, several hospitals achieved near-zero positive margin rates, suggesting opportunities for quality improvement through the identification of best practices among CRC surgery centers.

Indexed as

Cancer marginColorectal cancerHospital variationQuality of healthcare

Identifiers

PMID37766798
PMCPMC10520503

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.