Presence of Specialty Surgeons Reduces the Likelihood of Colostomy After Proctectomy for Rectal Cancer

PURPOSE: Geographic variability in the use of restorative proctectomy for rectal cancer has been described throughout the United States. We examined factors associated with high rates of colostomy formation after proctectomy for rectal cancer across US counties. METHODS: We used state hospital discharge data from 21 states to determine county rates of restorative proctectomy vs nonrestorative proctectomy (ie, colostomy) for rectal cancer. We merged the county-level data with 1) tumor characteristics from Surveillance Epidemiology and End Results data; 2) number of specialty surgeons in the American Society of Colon and Rectal Surgeons and Society of Surgical Oncology; 3) county socioeconomic variables from census data; 4) colorectal cancer-screening rates from Medicare; and 5) hospital characteristics from the American Hospital Association. We then determined factors associated with high rates of colostomy formation (> 60%) after proctectomy for rectal cancer across counties. RESULTS: From January 1, 2002, to December 31, 2004, a total of 19,912 proctectomies were performed for cancer in 1050 counties, of which 489 had adequate sample size for evaluation. Based on county of residence information, nonrestorative proctectomy with colostomy was performed in greater than 60% of all patients with rectal cancer in 26% (n = 125) of counties. On multivariate analysis, more specialty surgeons (OR = 0.70; CI = 0.51-0.96) were protective against colostomy formation at the county level. CONCLUSIONS: The use of restorative techniques in rectal cancer surgery varies based on access to specialty colorectal cancer surgeons. Population-based directives are needed to standardize care for rectal cancer across the United States.