Hospital Variation in 30-Day Mortality After Colorectal Cancer Surgery in Denmark

Osler, Merete; Iversen, Lene Hjerrild; Borglykke, Anders; Mårtensson, Solvej; Daugbjerg, Signe; Harling, Henrik; Jørgensen, Torben; Frederiksen, Birgitte

doi:10.1097/sla.0b013e318207556f

Cited by 58 publications

(43 citation statements)

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“…We also found that more than 40% of the variability in 30-day mortality for elective surgery was accounted for by the GSU volume, whereas no significant variation was found among GSUs for urgent surgery. This is in contrast with the results of a recent study in Denmark, in which a significant variation in mortality between low- and high-volume hospitals was found for urgent (but not elective) surgery [19].…”

Section: Discussioncontrasting

confidence: 99%

“…Specifically, urgent patients were about six times as likely to die within 30 days compared with elective patients. This finding is consistent with the literature, indicating that urgent procedures are strongly associated with adverse outcomes after colorectal resection [19], [37], [38], although these authors had a broader focus on colorectal surgery for any reason, and not only for CC. Furthermore, separate analyses carried out in urgent and elective patients revealed that the adjusted risk of post-operative mortality was increased in low-volume GSUs for elective CC surgery, but not for urgent surgery.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, little is known about the outcomes of CC surgery in elective and urgent patients. In a recent study carried out in Denmark, the authors found a significant variation in mortality between low- and high-volume hospitals for urgent surgery, but not for elective surgery [19].…”

Section: Introductionmentioning

confidence: 96%

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Impact of Procedure Volumes and Focused Practice on Short-Term Outcomes of Elective and Urgent Colon Cancer Resection in Italy

Lenzi

Lombardi²,

Gori

et al. 2013

PLoS ONE

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BackgroundThe relationship between hospital volumes and short-term patients’ outcomes of colon cancer (CC) surgery is not well established in the literature. Moreover, evidence about short-term outcomes of urgent compared with elective CC procedures is scanty. The aims of this study are 1) to determine whether caseloads and other hospital characteristics are associated with short-term outcomes of CC surgery; 2) to compare the outcomes of urgent and elective CC surgery.MethodsA total of 14,200 patients undergoing CC surgery between 2005 and 2010 in the General Surgery Units (GSUs) of the hospitals of Emilia-Romagna region, Northern Italy, were identified from the hospital discharge records database. The outcomes of interest were 30-day in-hospital mortality, re-intervention and 30-day re-admission. Using multilevel analysis, we analyzed the relationship of GSU volumes and focused practice, defined as the percentage of CC operations over total operations, with the three outcomes.ResultsHigh procedure volumes were associated with a lower risk of 30-day in-hospital mortality, after adjusting for patients’ characteristics [aOR (95% CI) = 0.51 (0.33–0.81)]. Stratified analyses for elective and urgent surgery showed that high volumes were associated with a lower 30-day mortality for elective patients [aOR (95% CI) = 0.35 (0.17–0.71)], but not for urgent patients [aOR (95% CI) = 0.72 (0.42–1.24)]. Focused practice was an independent predictor of re-intervention [aOR (95% CI) = 0.67 (0.47–0.97)] and re-admission [aRR (95% CI) = 0.88 (0.78–0.98)].ConclusionsThe present study adds evidence in support of the notion that patients with CC undergoing surgery at high-volume and focused surgical units experience better short-term outcomes.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

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Impact of Procedure Volumes and Focused Practice on Short-Term Outcomes of Elective and Urgent Colon Cancer Resection in Italy

Lenzi

Lombardi²,

Gori

et al. 2013

PLoS ONE

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“…7,18,19 Additionally, a nationwide study in Denmark has previously demonstrated variation in mortality after colorectal cancer surgery that is related to the ability of hospitals to care for emergency patients and those with high ASA classification. 20 While there is substantial evidence regarding identification of failure to rescue, there is much less evidence regarding ways to improve recognition and treatment of complications once they occur. Previous work has identified several hospital characteristics that influence failure to rescue rates and quality, including nurse to patient ratios.…”

Section: Discussionmentioning

confidence: 99%

Colon cancer operations at high- and low-mortality hospitals

Healy

Grenda

Suwanabol

et al. 2016

Surgery

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Introduction There is wide variation in mortality across hospitals for cancer surgery. While higher rates of mortality are commonly ascribed to high-risk resections, the impact on more common operations is unclear. We sought to evaluate causes of mortality following colon cancer operations across hospitals. Methods 49 American College of Surgeons Commission on Cancer (ACS-CoC) hospitals were selected for participation in a CoC special study. We ranked hospitals using a composite measure of mortality and performed onsite chart reviews. We examined patient characteristics and mortality following colon resections at very high mortality (HMH) and very low mortality (LMH) hospitals (2006–2007). Results We identified 3,025 patients who underwent surgery at 19 LMHs (n = 1,006) and 30 HMHs (n = 2,019). There were wide differences in risk-adjusted mortality between HMHs and LMHs (9.3% vs. 2.4%; P<0.001). Compared to LMHs, HMHs had more patients who were black (11.2% vs. 6.5%; P<0.001), had ≥2 comorbidities (22.7% vs. 18.9%; P<0.05), ASA class 4–5 (11.9% vs. 5.3%; P<0.001), and were functionally dependent (13.9% vs. 8.8%; P<0.001). Rates of any complication were similar in HMH’s vs. LMH’s (OR 1.29, 95% CI: 0.85 – 1.95). But, for those experiencing complications, case fatality rates were statistically significantly higher in HMHs vs. LMHs (OR 3.74, 95% CI: 1.59 – 8.82). Conclusions There is significant variation in mortality across hospitals for colon cancer surgery, despite similar perioperative morbidity. This finding reflects a need for improved surgical decision-making to enhance outcomes and quality of care at these hospitals.

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“…The need for a real‐world benchmark has generated interest in 30‐day mortality after SACT as a viable indicator to measure and audit for quality improvement purposes . This metric is not a new concept in cancer management as it has been widely used within the practice of surgical oncology for many years . However, within medical oncology circles, this has only started to gain momentum as a potential benchmark.…”

Section: Introductionmentioning

confidence: 99%

Thirty‐day mortality after systemic anticancer treatment as a real‐world, quality‐of‐care indicator: the Northland experience

Ang

Newton

2018

Internal Medicine Journal

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Hospital Variation in 30-Day Mortality After Colorectal Cancer Surgery in Denmark

Abstract: Hospital variation in 30-day mortality after CRC surgery are due to differences in hospitals' ability to take care of emergency patients, especially those with high ASA scores.

Cited by 58 publications

References 0 publications

Impact of Procedure Volumes and Focused Practice on Short-Term Outcomes of Elective and Urgent Colon Cancer Resection in Italy

Impact of Procedure Volumes and Focused Practice on Short-Term Outcomes of Elective and Urgent Colon Cancer Resection in Italy

Colon cancer operations at high- and low-mortality hospitals

Thirty‐day mortality after systemic anticancer treatment as a real‐world, quality‐of‐care indicator: the Northland experience

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