National accreditation program linked to better outcomes after major rectal cancer surgery
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National Accreditation Program for Rectal Cancer accreditation appeared associated with better outcomes for older adults who underwent major rectal cancer surgery, according to findings in Journal of the American College of Surgeons.
A review of more than 20,000 patients who underwent proctectomy showed lower risk-adjusted morbidity and mortality among those treated at National Accreditation Program for Rectal Cancer (NAPRC)-accredited hospitals.
Background
Rectal cancer outcomes have improved worldwide due to advances in surgical techniques and use of multimodal therapy. However, rectal cancer care still varies greatly across the country. Approximately half of patients with stage II or stage III rectal cancer undergo nonstandard treatment, according to study background. This may include incomplete surgical excision or omission of either neoadjuvant or adjuvant chemoradiation. Treatment inconsistencies have contributed to considerable variation in rectal cancer outcomes.
The American College of Surgeons established the NAPRC in 2017. The program defined a set of standards focused on evidence-based care processes, multidisciplinary program structure and internal audits designed to address highly variable rectal cancer practices and outcomes in hospitals across the United States.
More than 70 hospitals have achieved NAPRC accreditation by demonstrating compliance with each metric.
However, no large-scale studies had examined whether NAPRC accreditation has been associated with better rectal cancer outcomes.
Methods
Calista M. Harbaugh, MD, MSc, assistant professor of colorectal surgery at University of Michigan, and colleagues conducted a retrospective, observational study of Medicare beneficiaries with rectal cancer who underwent proctectomy between 2017 and 2020.
Researchers compared outcomes for patients treated at NAPRC-accredited and non-accredited hospitals.
Primary outcome measures included in-hospital, 30-day and 1-year mortality rates, as well as 30-day rates of complications, readmissions and reoperations.
The analysis included data from 20,202 patients aged 65 to 99 years treated at 1,985 hospitals, 65 (3.3%) of which had NAPRC accreditation. NAPRC-accredited hospitals more often were nonprofit and teaching hospitals with at least 250 beds.
One in 10 (n = 2,078; 10.2%) patients underwent proctectomy at an accredited hospital. Those treated at accredited hospitals more often underwent elective procedures with minimally invasive approaches and sphincter preservation.
Findings and next steps
Results showed significantly lower rates of in-hospital mortality (1.1% vs. 1.3%; P = .002), 30-day mortality (2.1% vs. 2.9%; P < .001) and 1-year mortality (11% vs. 12.1%; P < .001) among patients group treated at NAPRC-accredited hospitals.
Researchers also reported a lower 30-day complication rate at NAPRC-accredited hospitals (18.3% vs. 19.4%; P = .01).
“These results suggest that NAPRC hospitals provide safer surgical care, despite the fact that NAPRC standards do not directly address surgical safety,” Harbaugh and colleagues wrote. “Future work will seek to understand the underlying practices that lead to improved surgical outcomes in NAPRC centers.”
Perspective
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Arielle Kanters, MD
With the growing rates of colon and rectal cancer, our diligence and adherence to the delivery of high-quality cancer care is as important as ever. Though individual providers will take it upon themselves to optimize care, there are national organizations helping to ensure key standards are met.
The American College of Surgeons established the NAPRC in 2017 to tackle the challenging task of minimizing difference in rectal cancer care across the country.
Under the guidance of a multidisciplinary team of experts, a set of standards was established to guide institutions caring for patients with rectal cancer. Over the past 6 years, a growing number of hospitals have pursued accreditation by NAPRC and, now, nearly 100 hospitals have gained NAPRC status.
To better understand the effect of NAPRC accreditation status on patient outcomes, Harbaugh and colleagues conducted a study to compare patient outcomes after rectal cancer surgery at NAPRC-accredited and non-accredited institutions. They found that not only are patients treated at NAPRC-accredited hospitals more likely to undergo an elective procedure using a minimally invasive approach — for example, laparoscopic or robotic surgery — and sphincter preservation, they also have lower rates of 30-day complications, as well as lower rates of mortality at 30 days and 1 year.
These findings suggest that independent of oncologic outcomes, NAPRC-accredited hospitals may provide a higher quality of surgical care than those who have not undergone accreditation.
Cleveland Clinic was one of the first hospitals to receive NAPRC accreditation. Achieving this accreditation helps to set a high standard in delivering exceptional care to patients with rectal cancer at all of our locations.
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