Bayesian Approach Improves Efficiency of NSQIP Risk Adjustment

Baskin AS, Lark M, Fleischer CM, Kravchenko T, et al. Commission on Cancer Standard 5.7 Compliance and Technical Quality of Rectal Cancer Surgery: A National Cohort Study. J Am Coll Surg. August 2026.

Commission on Cancer (CoC) Operative Standard 5.7 requires documentation of complete or near-complete total mesorectal excision (TME) for eligible rectal cancer resections, but it is unknown whether facility compliance with Standard 5.7 reflects established measures of surgical quality.

This retrospective cohort study used the National Cancer Database linked to CoC accreditation data. Adults aged 18–90 years with clinical stage I–III rectal adenocarcinoma undergoing resection at CoC-accredited facilities between 2020 and 2023 were compared according to facility Standard 5.7 compliance. Primary outcomes were circumferential resection margin (CRM) positivity and TME grade; secondary outcomes included lymph node yield. Mixed-effects regression models adjusted for age, sex, Charlson-Deyo Comorbidity Index, clinical T stage, clinical N stage, tumor grade, and lymphovascular invasion.

Among 22,688 patients treated at 873 facilities, 91% underwent surgery at compliant hospitals. CRM positivity was lower at compliant facilities (12% versus 14%; adjusted OR, 0.82, 95% CI, 0.68–0.99; P=0.04). Patients treated at compliant facilities had greater odds of achieving a more complete TME (adjusted OR, 1.63, 95% CI, 1.21–2.19; P=0.001), with lower rates of incomplete TME (9% versus 14%; P<0.001). Although ≥12 lymph nodes were examined more frequently at compliant facilities (85% versus 81%; P<0.001), this association was not significant after adjustment (adjusted OR, 1.24, 95% CI, 0.99–1.55; P=0.06).

Standard 5.7 compliance was independently associated with lower CRM positivity and more complete TME, suggesting that the standard may serve as a meaningful facility-level indicator of technical quality in rectal cancer surgery. Whether these differences translate into improved long-term oncologic outcomes requires further study.