NAPRC-Accredited Hospitals vs Nonaccredited Hospitals: Proctectomy Outcomes

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Hospitals accredited by the American College of Surgeons (ACS) National Accreditation Program for Rectal Cancer (NAPRC) may demonstrate lower mortality and complication rates in patients undergoing proctectomy compared with nonaccredited hospitals, according to a recent study published by Harbaugh et al in the Journal of the American College of Surgeons.


In 2017, the ACS established the NAPRC to set rigorous standards centered on multidisciplinary program structure, evidence-based care processes, and internal auditing—which aim to address the variability in rectal cancer treatment practices and outcomes by ensuring that patients receive the highest quality of care.

“NAPRC accreditation differs fundamentally from other programs because it prioritizes processes over sheer volume or isolated outcomes,” explained lead study author Calista Harbaugh, MD, MSc, Assistant Professor in the Division of Colorectal Surgery at the University of Michigan. “It’s not merely about how many procedures we perform, but how we perform them, integrating multidisciplinary care, rigorous internal audits, and continuous improvement into the fabric of our treatment protocols,” she added.

Study Methods and Results

In the recent study, investigators analyzed the outcomes of Medicare beneficiaries who underwent proctectomy between 2017 and 2020. The investigators discovered that compared with those treated at nonaccredited hospitals, the patients who underwent proctectomy at NAPRC-accredited hospitals experienced lower rates of in-hospital mortality (1.1% vs 1.3%), 30-day mortality (2.1% vs 2.9%), 30-day complications (18.3% vs 19.4%), and 1-year mortality (11.0% vs 12.1%).

Despite the benefits, just 3.3% (n = 65 of 1,985) of the hospitals included in the study were accredited by NAPRC. However, the accredited centers were able to treat a larger proportion of patients. For instance, among 20,202 patients, 10% (n = 2,078) of them underwent proctectomy at an NAPRC-accredited hospital.


The investigators noted that NAPRC accreditation may improve outcomes as a result of its emphasis on multidisciplinary care and stringent process standards, which include comprehensive pre- and postoperative assessments, ensuring a higher quality of care. The focus on collaborative care, meticulous reviews, and adherence to structured treatment protocols could be crucial elements enhancing patient safety and reducing mortality and complications after proctectomy. The findings also demonstrate that NAPRC-accredited hospitals were more likely to be nonprofit teaching institutions with larger bed capacities than nonaccredited hospitals.

The investigators reported that their research may not have captured hospitals in the process of becoming accredited, since a facility must demonstrate 12 months of compliance with all of the NAPRC standards before accreditation.

They hope to extend the scope of their future studies beyond 1-year survival rates to examine long-term oncologic outcomes. With a deeper analysis of the quality of surgical outcomes over a more extended period, this research could provide more comprehensive insights into longevity and quality of life in patients after proctectomy. Longitudinal studies could help identify the long-term impacts of adherence to NAPRC standards on survival, recurrence rates, and other critical oncologic outcomes.

“Our findings suggest that adherence to NAPRC standards can significantly improve the outcomes for patients undergoing major rectal cancer surgery. The accreditation process, while resource intensive, holds the potential to elevate the standard of care and reduce morbidity and mortality associated with rectal cancer surgery,” concluded Dr. Harbaugh.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.