Have changes in colorectal surgery training impacted on mortality in cancer patients? A retrospective cohort study of 51,562 procedures

TL;DR

This study found that changes in colorectal surgery training in the UK were linked to lower cancer patient mortality rates after surgery.

Contribution

The study links modern surgical training reforms to reduced postoperative cancer mortality in colorectal surgery.

Findings

Post-Calman trained consultants had a lower adjusted 90-day mortality rate than pre-Calman trained consultants.

Post-Calman trained consultants performed fewer procedures on average compared to pre-Calman trained consultants.

The proportion of female consultants increased significantly after the Calman training reforms.

Abstract

The aim of this study was to explore whether there were any differences in consultant colorectal surgeon training and adjusted 90-day postoperative colorectal cancer mortality rates (AMR).

We undertook a retrospective analysis of outcomes data published on the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. A total of 51,562 procedures for patients in England diagnosed with large bowel cancer between 2010 and 2015, registered under 551 consultants were included. Consultants were split into two cohorts. The first group were the pre-Calman Trained Consultants (pre-CTr), who completed their training before 1998. The second group—the post-Calman Trained Consultants (post-CTr)—included those who received their Certificate of Completion of Training (CCT) under the Calman Training Principles (CTC, 1998–2007) and the Modernising Medical Careers Curriculum (MMC, 2008 and onwards). The outcome measure was an AMR.

The pre-CTr cohort (n=84) consisted of 3.6% female colorectal consultants (n=3/84), whereas the post-CTr cohort (n=467) consisted of 14.3% female colorectal consultants (n=67/467) (p=0.006). In this cross-sectional analysis over 5 years, the average pre-CTr undertook a greater number of colorectal resections than their post-CTr peers: median procedures (interquartile range, IQR): 104 (59) vs 89 (57) respectively, p=0.008. The median AMR was significantly greater among pre-CTrs compared with post-CTrs, median AMR (IQR): 2.7% (2.0) vs 2.1% (2.9), p=0.022.

These data indicate that the implementation of the MMC and Calman training principles for colorectal training is associated with a statistically lower AMR compared with other historical training periods. This merits further exploration.

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