Failure to Rescue in Postoperative Patients With Colon Cancer: Time to Rethink Where You Get Surgery

Pandit, Viraj; Jehan, Faisal; Zeeshan, Muhammad; Koblinski, Jenna E.; Martínez, Carolina; Khan, Muhammad; Mogor, Odinaka P.; Nfonsam, Valentine

doi:10.1016/j.jss.2018.08.046

Cited by 13 publications

(11 citation statements)

References 18 publications

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“…Similarly, other studies have shown that academic and teaching status affects FTR rates after surgery. 11,13,15,19,20 Several studies from the Dutch Colorectal Audit have highlighted this association when looking at hospitals' academic status. Henneman et al was the first group to look at 3 different structural hospital factors and found that high surgical case volume, university status, and greater access to critical care significantly lowered crude FTR rates.…”

Section: Discussionmentioning

confidence: 99%

Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery

Lillo-Felipe¹,

Hulme²,

Sjölin³

et al. 2021

Surgery

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Background: Failure-to-rescue is a quality indicator measuring the response to postoperative complications. The current study aims to compare failure-to-rescue in patients suffering severe complications after surgery for colorectal cancer between hospitals based on their university status. Methods: Patients undergoing colorectal cancer surgery from January 2015 to January 2020 in Sweden were included through the Swedish Colorectal Cancer Registry in the current study. Severe postoperative complications were defined as Clavien-Dindo 3. Failure-to-rescue incidence rate ratios were calculated comparing university versus nonuniversity hospitals. Results: A total of 23,351 patients were included in this study, of whom 2,964 suffered severe postoperative complication(s). University hospitals had lower failure-to-rescue rates with an incidence rate ratios of 0.62 (0.46e0.84, P ¼ .002) compared with nonuniversity hospitals. There were significantly lower failure-to-rescue rates in almost all types of severe postoperative complications at university than nonuniversity hospitals. Conclusion: University hospitals have a lower risk for failure-to-rescue compared with nonuniversity hospitals. The exact mechanisms behind this finding are unknown and warrant further investigation to identify possible improvements that can be applied to all hospitals.

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Section: Discussionmentioning

confidence: 99%

Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery

Lillo-Felipe¹,

Hulme²,

Sjölin³

et al. 2021

Surgery

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“…In our study, 904/3245 (27.9%) screened and 1800/5383 (33.6%) unscreened cases aged 52-74 experienced a serious post-operative complication after colon cancer resection. A US study of colon cancer resection in 2011 12 reported a slightly lower range of serious postoperative complications (19.4% in urban populations and 24.9% in rural populations) among all cases undergoing resection at age 518 years; however, among US colorectal cancer resections in 2014-2015, serious complications were reported in 21.3% to 33.9%, depending on hospital volume, of all resections among those aged 518. 13 Reports of postoperative mortality following major large bowel resection for CRC in the contemporary era are characterized by substantial variability in terminology, which causes difficulties in making comparisons between reports, or between our study and other reports.…”

Section: Discussionmentioning

confidence: 97%

“…1% after rectal resection, in a population of whom 35,223/113,283 (31.1%) were aged 580 20. From the US National In-Patient Database, in-hospital mortality in 2011 was reported as 2.9% to 3.1%, and during 2014 to 2015 as 2.2% to 4.5%, among all cases aged 518 12.…”

mentioning

confidence: 99%

Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

Paszat

Sutradhar

Corn³

et al. 2020

J Med Screen

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Background and aims In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program. Methods We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50–74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50–74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts. Results Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively. Conclusion Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.

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“… 18 – 20 A report on surgery for benign colorectal polyps, without information on method of detection, between 2005 and 2015 in the Noord-Holland province of the Netherlands 21 found that the rate was stable across the period, with 318/915 (34.8%) experiencing one or more adverse events and postoperative mortality in 13/915 (1.4%). By comparison, contemporary population-based reports of postoperative complications and mortality after resection of CRC, regardless of detection by screening or symptomatic presentation, report that from 19.4% to 33.9% experience major complications 22 – 24 depending on age and institution characteristics, and that 1.0% to 6.7% of cases result in postoperative death, depending on age and definitions of the period of observation for postoperative mortality. 25 – 31 At present, there are no publications on overall complications and mortality following major large bowel resection for CRC in Ontario during this observation period (2008 to 2017).…”

Section: Discussionmentioning

confidence: 98%

Morbidity and mortality after major large bowel resection of non-malignant polyp among participants in a population-based screening program

et al. 2020

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Background and aims Colonoscopy following positive fecal occult blood screening may detect non-malignant polyps deemed to require major large bowel resection. We aimed to estimate the major inpatient morbidity and mortality associated with major resection of non-malignant polyps detected at colonoscopy following positive guaiac fecal occult blood screening in Ontario's population-based colorectal screening program. Methods We identified those without a diagnosis of colorectal cancer in the Ontario Cancer Registry ≤24 months following the date of colonoscopy prompted by positive fecal occult blood screening between 2008 and 2017, who underwent a major large bowel resection ≤24 months after the colonoscopy, with a diagnosis code for non-malignant polyp, in the absence of a code for any other large bowel diagnosis. We extracted records of major inpatient complications and readmissions ≤30 days following resection. We computed mortality within 90 days following resection. Results For those undergoing colonoscopy ≤6 months following positive guaiac fecal occult blood screening, 420/127,872 (0.03%) underwent major large bowel resection for a non-malignant polyp. In 50/420 (11.9%), the resection included one or more rectosigmoid or rectal polyps, with or without a colonic polyp. There were one or more major inpatient complications or readmissions within 30 days in 117/420 (27.9%). Death occurred within 90 days in 6/420 (1.4%). Conclusions Serious inpatient complications and readmissions following major large bowel resection for non-malignant colorectal polyps are common, but mortality ≤90 days following resection is low. These outcomes should be considered as unintended adverse consequences of population-based colorectal screening programs.

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Failure to Rescue in Postoperative Patients With Colon Cancer: Time to Rethink Where You Get Surgery

Cited by 13 publications

References 18 publications

Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery

Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery

Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

Morbidity and mortality after major large bowel resection of non-malignant polyp among participants in a population-based screening program

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