Association of Traditional and New Surgical Wait Time Targets and Survival for Curative-intent Colorectal Cancer Surgery
Bibliographic record
Abstract
BACKGROUND: Wait time (WT) to surgery is a common quality indicator for colorectal cancer (CRC). However, the definition of WT targets and its association with clinically relevant outcomes remains poorly defined. We assessed the association between WT to CRC surgery and overall survival (OS) for curative-intent surgery. METHODS: We conducted a population-based retrospective cohort study of adults undergoing resection for stage I to III CRC (between 2007 and 2020), using health administrative data in Ontario, Canada. The exposure was WT, measured as the time from the decision to operate to surgery (in days). The outcome was OS, measured as time from surgery to death. Restricted cubic spline regression (RCS) examined the relationship between WT and hazards of death to identify meaningful WT thresholds. WT was then categorized as (a) traditional WT target (≤ 28 days) or (b) new data-informed target defined by RCS. Multivariable Cox proportional hazards explored the association between each WT target and the hazards of death after adjusting for confounders established a priori. RESULTS: Of 35,533 patients, 27,102 (76.3%) underwent surgery within the traditional WT target. The median WT was 19 days (interquartile range: 12-28). RCS revealed an inflection point around 45 days associated with increasing hazards of death. After adjusting for age, sex, comorbidity, cancer site, stage, neo-adjuvant or adjuvant therapy, and year of surgery, having surgery within the traditional WT target (≤ 28 days) was not associated with OS [hazards ratio (HR): 0.97; 95% CI: 0.92-1.02]. Having surgery within the new WT target (≤ 45 days) was independently associated with superior OS (HR: 0.90, 95% CI: 0.82-0.99). CONCLUSIONS: In patients undergoing curative-intent resection for stage I to III CRC, having surgery within traditional WT target of 28 days was not associated with OS. However, having surgery within a WT target of 45 days was independently associated with superior OS. These data highlight the need to reconsider WT targets for quality monitoring by linking to clinically meaningful outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".