The mortality rate for patients who had colorectal surgery over an eight-year period (1988-1994) performed by board-certified colon and rectal surgeons was 1.4 percent, compared to 7.3 percent for a similar group of patients operated on by other surgeons, according to a study published in the February issue of Diseases of the Colon & Rectum (DC&R), Journal of the American Society of Colon and Rectal Surgeons.

The study by Lester Rosen, M.D,, John J. Stasik, Jr., M.D., and others at the Lehigh Valley Hospital Allentown, PA, covered 2,805 patients treated by 39 surgeons. Six of the 39 surgeons were board-certified colon and rectal specialists. They performed 56 percent of the surgeries.

Beginning in 1989, all hospitalized patients were assigned to an admission severity group (ASG) from 0 (minimal or no risk of vital organ failure or medical instability with a very low risk of death) to 4 (vital organ failure and medical instability with a much greater risk of death). The ASG ranking is part of system for analysis of clinical information used by the Pennsylvania Health Care Cost Containment Council,an agency established by the state legislature to address problems of escalating health costs, to insure the quality of health care1 and to increase access to health care services for all citizens.

A review of the files of 1,753 patients for whom ASG data were available showed that board-certified colorectal surgeons had a mortality rate of 0.8 percent for the sicker patients in ASG 2, compared to 3.8 percent for other surgeons, and 5.7 percent in ASG 3, compared to 16.4 percent for non-specialists.

Colorectal specialists were also able to release patients in ASG 2 and ASG 3 from the hospital sooner than other surgeons, according to the study. ASG 2 patients treated by colorectal specialists spent an average 12.3 days in the hospital, compared to 16.1 days for other Surgeons' patients. In ASG 3, the difference was 17.0 days versus 21.2 days.

"Managed care and state and federal Organizations are focusing on comparative outcomes with increasingly sophisticated data retrieval and analysis systems to ensure validity," the study concludes. "Changes in delivery of health care (i.e., despecial-ization) based on these systems are controversial. Despecialization of surgical care, particularly for high-risk patients, is unacceptable if superior quality is demonstrated by legislated Outcome databases."

The executive office of the 1,800-member American Society of Colon and Rectal Surgeons is located in the Chicago suburb of Arlington Heights. Board-certified colon and rectal surgeons complete a residency in general surgery, plus an additional year in colon and rectal surgery, and pass an intensive examination conducted by the American Board of Colon and Rectal Surgery

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