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The National Bowel Cancer Project: Social Deprivation Is an Independent Predictor of Nonrestorative Rectal Cancer Surgery

Tilney, Henry M.R.C.S.1; Lovegrove, Richard E. M.R.C.S.1; Smith, Jason J. M.D., F.R.C.S.2; Thompson, Michael R. M.D., F.R.C.S.3; Tekkis, Paris P. M.D., F.R.C.S.1on behalf of the Association of Coloproctology of Great Britain and Ireland

Diseases of the Colon & Rectum: June 2009 - Volume 52 - Issue 6 - p 1046-1053
doi: 10.1007/DCR.0b013e3181a65f41

PURPOSE: This study was designed to assess the impact of social deprivation on rates of abdominoperineal excision of the rectum in the United Kingdom.

METHODS: Data were extracted from the Association of Coloproctology of Great Britain and Ireland Colorectal Cancer Database (2000-2005). Social deprivation was assessed by using the Index of Multiple Deprivation (2004) score. Logistic regression was performed to identify independent predictors of nonrestorative surgery.

RESULTS: A total of 12,128 patients underwent anterior resection or abdominoperineal excision for Dukes A-C cancer in 101 centers; 2,625 patients (21.6 percent) underwent abdominoperineal excision (median, 20.8 (interquartile range, 16.5-27.9) percent per unit). Abdominoperineal excision rates decreased from 24.3 to 18.2 percent (P < 0.001) and varied between the least and most deprived groups from 18 to 26.4 percent, respectively (P < 0.001). Independent predictors of abdominoperineal excision were: year of surgery (odds ratio = 0.855 per year increase, P < 0.001), female vs. male gender (odds ratio = 0.82, P < 0.001), use of neoadjuvant radiotherapy (odds ratio = 2.4, P < 0.001), and social deprivation (most vs. least deprived: odds ratio = 1.638, P < 0.001).

CONCLUSIONS: Abdominoperineal excision rates vary considerably between centers. Gender and deprivation status independently predict formation of a permanent stoma. These results have important implications for intercenter comparisons of surgical quality and may suggest inequalities in health care provision.

1 Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College, London, United Kingdom

2 Department of Surgery, West Middlesex Hospital, London, United Kingdom

3 Department of Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom

Supported by The Health Foundation, United Kingdom.

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

Address of correspondence: Paris P. Tekkis, M.D., F.R.C.S., Imperial College London, Department of Biosurgery and Surgical Technology, St. Mary's Hospital, 10th Floor, QEQM Wing, Praed Street, London W2 1NY, United Kingdom. E-mail:

© The ASCRS 2009