Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

Abstract

Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.

Validation of MTL30 as a quality indicator for colorectal surgery

“…Because morbidity and mortality decrease with the number of surgeries performed in hospitals [3,4], "minimum quantities" have been recommended internationally. This has led to centralization in high volume centers [21,22], but without necessarily improving surgical care.…”

“…Treatment quality and the adequate management of complications arising from surgery are therefore critical factors for therapeutic success [2]. Numerous studies have shown that complication rates largely depend on patient-specific factors such as age or the ASA score on the one hand, and on the infrastructure of the treating hospital and its expertise for specific procedures on the other [3][4][5][6][7].…”

Defining benchmarks for robotic-assisted low anterior rectum resection in low-morbid patients: a multicenter analysis

“…In 2020, Diers et al published their paper reporting the nationwide in-hospital mortality rate following rectal resection for rectal cancer [11]. They found a mortality rate of 1.5% in very high output centers (case load > 50 per year) and 1.4% in high output center (case load around 32 patients per year), but with approximately 15% of the cases being emergency procedures.…”

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

“…16 However, de Neree 17 reported the composite 30 day plus inpatient mortality in 2015-2016 as 1.8% for colon cancer and 1.0% for rectal cancer, similar to screen-detected cases in our study. Diers et al 18 reported nationwide postoperative inpatient mortality between 4.8% and 6.9% in Germany in 2012-2015; 59,515/129,196 (46.1%) of cases were aged 575. However, among the 57,948/129,196 (44.9%) aged 55-74, the mortality was 3.2%.…”