Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon: Utilidad de los índices de propensión (propensity scores) Influence of surgeon specialization on outcomes following surgery for colon cancer: The usefulnes of propensity scores

Introducción: la influencia del factor cirujano en el cáncer colorrectal se ha estudiado de manera reiterada en literatura científica, pero los resultados han sido contradictorios. Se plantea en este estudio si la especialización del cirujano es un factor determinante del pronóstico en estos pacientes. Asimismo, se valora la importancia de los índices de propensión (PS) en el análisis de los resultados. Pacientes y métodos: se planteó un estudio retrospectivo con revisión de las historias clínicas de 236 pacientes sometidos a cirugía por cáncer de colon en el Hospital General de Castellón. Se establecieron dos grupos de cirujanos (especialista y no especialista), comparando los resultados en cuanto a supervivencia y en cuanto a intervalo libre de enfermedad a los 5 años. Inicialmente, se realizaron las comparaciones sin el ajuste de los resultados y, posteriormente, utilizando los PS. Resultados: el primer análisis de los resultados (sin ajuste) fue claramente favorable al grupo de cirujanos especialistas (supervivencia a los 5 años del 64,3 frente al 79,3%, p = 0,028). No obstante, cuando se ajustó mediante los PS, no se obtuvo dicha significación estadística. Conclusiones: no se ha podido demostrar que la especialización del cirujano sea un factor determinante del pronóstico en los pacientes sometidos a cirugía por cáncer de colon. Los índices de propensión pueden ser de gran utilidad para el ajuste de los resultados en estudios retrospectivos no aleatorizados, especialmente cuando el factor de estudio es poco frecuente.Introduction: surgeon influence on colorectal cancer surgery outcomes has been repeatedly studied in the scientific literature, but conclusions have been contradictory. Here we study whether surgeon specialization is a determinant factor for outcome in these patients. The importance of propensity scores (PS) in surgical research is also studied. Patients and methods: a retrospective study was performed and medical records were reviewed for 236 patients who were intervened for colon cancer in Castellon General Hospital (Spain). Cases were divided into two groups (specialist and non-specialist surgeons), and both 5-year surveillance and disease free survival were compared. Comparisons were first made with no adjustments, and then subsequently using PS analysis. Results: the initial (non-adjusted) analysis was clearly favourable for the specialist surgeon group (5-year surveillance, 64.3 vs. 79.3%, p = 0.028). After adjusting for PS no statistical significance was obtained. Conclusions: surgeon specialization had no significant impact on patient outcome after colon cancer surgery. Propensity score analysis is an important tool in the analysis of surgical non-randomized studies, particularly when events under scrutiny are rare

Measuring Success Factors of Quality Management in the Shipping Industry

It is generally accepted that quality management is considered a valuable competitive factor for firms that confers them competitive advantages and enables them to achieve superior performance. Although there have been numerous studies examining general quality management practices and implementation, industry-specific studies on quality management practices and factors that influence their success in the shipping industry are rather few. This study seeks to identify the factors that are critical to successful quality management, and attempts to develop a reliable, empirically tested, and rigorously validated measurement instrument for quality management, for the shipping industry. We conducted a large-scale survey of shipping industry executives and applied a rigorous research methodology to treat the survey data. We identified four success factors of quality management, which are top management commitment and participation, quality information and performance measurement, employee training and empowerment, and customer focus, and developed a functional instrument to measure quality management in the shipping industry. This paper contributes to research by identifying the success factors of quality management, and provides managerial insights on the successful management of quality, in the shipping industry. Maritime Economics & Logistics (2007) 9, 234–253. doi:10.1057/palgrave.mel.9100179