Mapping Colorectal Practice Patterns in a Community Hospital: A Correspondence Analysis Approach

This single-surgeon, single-institution study aims to show the association between perioperative variables and surgical technique in colorectal surgery, assess discrepancies in patient management relative to established guidelines, and identify underlying causes for improvement. Because the findings reflect one surgeon's practice at one hospital, they are intended as a reproducible audit methodology for single providers rather than as generalizable clinical guidance.

A total of 171 patients underwent colorectal surgery at The Brooklyn Hospital between 2017 and 2024, including 73 robot-assisted, 62 open, and 36 laparoscopic procedures. The primary analysis examined the relationship between surgical technique and diagnosis. Secondary, exploratory analyses evaluated associations between surgical technique and 14 preoperative variables, and surgical technique and 14 postoperative variables. We assessed associations using chi-square tests, with likelihood-ratio chi-square tests when more than 20% of expected cell counts were below 5, along with correspondence analysis. To account for the five planned comparisons, we set statistical significance at α =0.01 using a Bonferroni correction.

The most common surgical indications were ascending colon cancer (27 cases), diverticulitis (25 cases), and colostomy reversal (20 cases). The technique-diagnosis association was statistically significant (χ² = 102.83, df = 28, p < 0.0001, Cramér's V = 0.51): laparoscopic surgery was most frequently associated with volvulus surgery, robotic technique with ascending colon cancer and colovesicular fistula surgeries, and open surgery with ileostomy reversal surgery. The technique-preoperative association was not statistically significant (χ² = 32.71, df = 26, p = 0.17); the exploratory associations included laparoscopic technique with male sex and NSAID use, and robotic technique with elective procedures and prior radiation. The association between surgical technique and postoperative outcomes was significant on likelihood-ratio testing (G = 41.38, df = 26, p = 0.028), but did not meet the Bonferroni-adjusted significance threshold. Correspondence analysis showed that laparoscopic surgery was associated with surgical site infection, while robotic surgery was associated with shorter hospital stays and earlier return of bowel function.

This study explores one surgeon's practice in the key relationships between surgical techniques and patient characteristics, highlighting their impact on surgical outcomes. It identifies distinct trends in using laparoscopic, robotic, and open surgeries. This practice follows established practice, utilizing preoperative collaboration in optimizing surgical care. The methodology of this analysis, although pertaining to one practice, can be applied to any surgeon's data to audit practice patterns and identify areas of improvement.