BMJ 1999;319:576 ( 28 August )

Letters

Number of cases operated on is important in volume-outcome debate for colorectal cancer

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EDITOR---Comber draws a distinction between hospital based registration systems and a population based registry and raises the possibility that we missed cases of colorectal cancer. 1 2

The leaders of both the Northern Ireland cancer register and the colorectal cancer register have shared their data for several years. Those at the colorectal cancer register are aware that their ascertainment focuses on patients having surgical intervention. As our paper indicated,2 we focused our analysis on patients who had surgical intervention as this seems to be the most obvious first step in analysing the volume-outcome debate. We know from the hospital patient administration systems that during 1990-4, 3414 inpatient episodes had a diagnosis of colorectal cancer and an OPCS-IV operation code3 of HO4-H20, H30, H20-H28, or H33-H41. The episode count over a period almost certainly overestimates the number of patients having these operations with a diagnosis of colorectal cancer,4 and so it is . . . [Full text of this article]
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