Faculty Collaboration Database

Colon cancer operations at high- and low-mortality hospitals. Surgery 2016 Aug;160(2):359-65

Date

06/19/2016

Pubmed ID

27316824

Pubmed Central ID

PMC4938751

DOI

10.1016/j.surg.2016.04.035

Scopus ID

2-s2.0-84979687051 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: There is wide variation in mortality across hospitals for cancer operations. 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: Forty-nine American College of Surgeons Commission on Cancer hospitals were selected for participation in a Commission on Cancer 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 and very low- mortality hospitals (2006-2007).

RESULTS: We identified 3,025 patients who underwent an operation at 19 low-mortality (n = 1,006) and 30 high-mortality (n = 2,019) hospitals. There were wide differences in risk-adjusted mortality between high-mortality and low-mortality hospitals (9.3% vs 2.4%; P < .001). Compared with low-mortality hospitals, high-mortality hospitals had more patients who were black (11.2% vs 6.5%; P < .001), had ≥2 comorbidities (22.7% vs 18.9%; P < .05), were categorized American Society of Anesthesiologists class 4-5 (11.9% vs 5.3%; P < .001), and were functionally dependent (13.9% vs 8.8%; P < .001). Rates of complication were similar in high-mortality versus low-mortality hospitals (odds ratio 1.29, 95% confidence interval, 0.85-1.95). For those experiencing complications, though, case fatality rates were significantly higher in high-mortality versus low-mortality hospitals (odds ratio 3.74, 95% confidence interval, 1.59-8.82).

CONCLUSION: There is significant variation in mortality across hospitals for colon cancer operations, despite similar perioperative morbidity. This finding reflects a need for improved operative decision-making to enhance outcomes and quality of care at these hospitals.

Author List

Healy MA, Grenda TR, Suwanabol PA, Yin H, Ghaferi AA, Birkmeyer JD, Wong SL

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Colectomy
Colonic Neoplasms
Female
Hospital Mortality
Humans
Male
Middle Aged
Neoplasm Staging
Postoperative Complications
Retrospective Studies
Risk Adjustment
Survival Rate
United States