To the Editor—I read the timely paper by Ricciardi and colleagues entitled “The Status of Radical Proctectomy and Sphincter-Sparing Surgery in the United States” with great interest.
1 This represents another intriguing study utilizing an administrative database to draw conclusions about the quality of care. One could quibble about the accuracy of the data because these databases are not primarily intended to measure quality and are missing key pieces of information. For example, there is no way of knowing what the criteria were for coding a tumor as rectosigmoid
vs. rectal what the distance of the tumor was from the anal verge, the tumor stage,
etc. Without this type of data, it is very difficult to know whether the care of the patients was appropriate. Further, anyone who has looked at the discharge diagnoses supplied by the coders at their hospital will recognize the occasional distant relationship between reality and what is listed on the face sheet in the discharge data set. Nonetheless, the authors readily acknowledge the drawbacks of the database and the conclusions of this paper ring true. We do need to do better and learn from the European “centers of excellence” initiatives that clearly seem to have improved the outcomes for patients with rectal cancer. …
