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Does it matter where you get your surgery for colorectal cancer?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The influence of hospital-related factors on outcomes following colorectal surgery is not well-established. The aim of our study was to evaluate the relationship between hospital factors on outcomes in surgically managed colorectal cancer patients.

Methods

We performed a 2-year (2014–2015) analysis of the NIS database. Adult (> 18 years) patients who underwent open or laparoscopic colorectal resection were identified using ICD-9 codes. Patients were stratified based on hospital: volume (low vs. high), teaching status, and location (urban vs. rural). Outcome measures were complications and mortality. Multivariate logistic regression was performed.

Results

A total of 153,453 patients with CRC were identified of which 35.3% underwent surgical management. Mean age was 69 ± 13 years, 51.6% were female, and 67% were white. Twenty-seven percent of the patients were managed at a high-volume center, 48% at intermediate-volume center while 25% at a low-volume center. Complications and mortality rates were lower in patients who were managed at high-volume centers and urban hospitals, while no difference was noticed based on teaching status. On regression analysis, patients managed at high-volume centers (OR 0.76 [0.56–0.89]) and urban hospitals (OR 0.83 [0.64–0.91]) have lower odds of complications; similarly, high-volume centers (OR 0.79 [0.65–0.90]) and urban facility (OR 0.87 [0.70–0.92]) were associated with lower odds of mortality. However, there was no association between teaching status and outcomes.

Conclusion

Hospital factors significantly influence outcomes in patients with CRC managed surgically. High-volume centers and urban facilities have relatively better outcomes. Regionalization of care along with the appropriate availability of resources may improve outcomes in patients with CRC.

Level of evidence

Level III, Retrospective Observational Study

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References

  1. Marley AR, Nan H (2016) Epidemiology of colorectal cancer. Int J Mol Epidemiol Genet 7:105–114

    PubMed  PubMed Central  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34

    Article  PubMed  Google Scholar 

  3. Nelson RL, Persky V, Turyk M (1999) Determination of factors responsible for the declining incidence of colorectal cancer. Dis Colon Rectum 42:741–752

    Article  CAS  PubMed  Google Scholar 

  4. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66:683–691

    Article  PubMed  Google Scholar 

  5. Aziz H, Pandit V, DiGiovanni RM, Ohlson E, Gruessner AC, Jandova J, Nfonsam VN (2015) Increased incidence of early onset colorectal cancer in Arizona: a comprehensive 15-year analysis of the Arizona Cancer Registry. J Gastrointest Dig Syst 5:345

    PubMed  PubMed Central  Google Scholar 

  6. Kolligs FT (2016) Diagnostics and epidemiology of colorectal cancer. Visc Med 32:158–164

    Article  PubMed  PubMed Central  Google Scholar 

  7. Schrag D, Panageas KS, Riedel E, Hsieh L, Bach PB, Guillem JG, Begg CB (2003) Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol 83:68–78

    Article  PubMed  Google Scholar 

  8. van der Geest LGM, van Rijssen LB, Molenaar IQ, de Hingh IH, Groot Koerkamp B, Busch ORC, Lemmens VEPP, Besselink MGH, Dutch Pancreatic Cancer G (2016) Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB (Oxford) 18:317–324

    Article  Google Scholar 

  9. Pandit V, Jehan F, Zeeshan M, Koblinski JE, Martinez C, Khan M, Mogor OP, Nfonsam V (2019) Failure to rescue in postoperative patients with colon cancer: time to rethink where you get surgery. J Surg Res 234:1–6

    Article  PubMed  Google Scholar 

  10. Shafi S, Nathens AB, Parks J, Cryer HM, Fildes JJ, Gentilello LM (2008) Trauma quality improvement using risk-adjusted outcomes. J Trauma Acute Care Surg 64:599–606

    Article  Google Scholar 

  11. Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 250:1029–1034

    Article  PubMed  Google Scholar 

  12. Morche J, Mathes T, Pieper D (2016) Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Systematic Rev 5:204

    Article  Google Scholar 

  13. Finlayson EVA, Birkmeyer JD (2003) Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis. J Am Coll Surg 196:410–417

    Article  PubMed  Google Scholar 

  14. Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB (2001) The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 345:181–188

    Article  CAS  PubMed  Google Scholar 

  15. Billingsley KG, Morris AM, Dominitz JA, Matthews B, Dobie S, Barlow W, Wright GE, Baldwin L-M (2007) Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg 142:23–31

    Article  PubMed  Google Scholar 

  16. Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB (2000) Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 284:3028–3035

    Article  CAS  PubMed  Google Scholar 

  17. Hartz AJ, Krakauer H, Kuhn EM, Young M, Jacobsen SJ, Gay G, Muenz L, Katzoff M, Bailey RC, Rimm AA (1989) Hospital characteristics and mortality rates. N Engl J Med 321:1720–1725

    Article  CAS  PubMed  Google Scholar 

  18. Gordon TA, Burleyson GP, Tielsch JM, Cameron JL (1995) The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 221:43

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bergin RJ, Emery J, Bollard RC, Falborg AZ, Jensen H, Weller D, Menon U, Vedsted P, Thomas RJ, Whitfield K (2018) Rural–urban disparities in time to diagnosis and treatment for colorectal and breast cancer. Cancer Epidemiology and Prevention Biomarkers 27:1036–1046

    Article  Google Scholar 

  20. McCullough LE, Flowers CR (2018) Identifying and addressing disparities in survival outcomes for rural patients with cancer disparities in survival outcomes for rural patients with cancerinvited commentary. JAMA Netw Open 1:e181243-e

    Article  Google Scholar 

  21. McNulty JA, Nail L (2015) Cancer survivorship in rural and urban adults: a descriptive and mixed methods study. J Rural Health 31:282–291

    Article  PubMed  Google Scholar 

  22. Unger JM, Moseley A, Symington B, Chavez-MacGregor M, Ramsey SD, Hershman DL (2018) Geographic distribution and survival outcomes for rural patients with cancer treated in clinical trials. JAMA Netw Open 1:e181235-e

    Article  Google Scholar 

  23. Livingston EH (2010) Teaching hospital status and operative mortality in the United States. Arch Surg 145:1025

    Article  PubMed  Google Scholar 

  24. van Groningen JT, Eddes EH, Fabry HFJ, van Tilburg MWA, van Nieuwenhoven EJ, Snel Y, van de Mheen PJM, de Noo ME (2018) Dutch Surgical Colorectal Cancer Audit G. Hospital teaching status and patients’ outcomes after colon cancer surgery. World J Surg:1–9

  25. Pandit V, Memeh K, Omesiete P, Ewongwo AN, Mogor OP, Chen D, Nfonsam VN. Resident involvement and outcomes after surgery for colorectal cancer. In: Editor ed.^eds. Book resident involvement and outcomes after surgery for colorectal cancer. 5 ed. City: LIPPINCOTT WILLIAMS & WILKINS TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA …:E130-E1.

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Authors and Affiliations

  1. Department of Surgery, University of Arizona Medical Center, Tucson, USA

    Mohammad Hamidi, Kamil Hanna, Pamela Omesiete, Alejandro Cruz, Agnes Ewongwo, Viraj Pandit, Bellal Joseph & Valentine Nfonsam

Authors
  1. Mohammad Hamidi
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  2. Kamil Hanna
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  3. Pamela Omesiete
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  4. Alejandro Cruz
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  5. Agnes Ewongwo
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  6. Viraj Pandit
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  7. Bellal Joseph
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  8. Valentine Nfonsam
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Contributions

Study design and conception: VN, MH, KH, AE, BJ, VP

Data acquisition: AC, VN, KH, MH, PO

Statistical analysis: PO, VN, KH, MH

Manuscript writing: AE, MH, KH, VN, VP

Critical revision: AC, VN, KH, MH, PO, VP, BJ

Corresponding author

Correspondence to Valentine Nfonsam.

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The authors declare that they have no conflict of interest.

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Poster Presentation at the American Society of Colon and Rectal Surgeons, June 2019; Cleveland, Ohio

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Hamidi, M., Hanna, K., Omesiete, P. et al. Does it matter where you get your surgery for colorectal cancer?. Int J Colorectal Dis 34, 2121–2127 (2019). https://doi.org/10.1007/s00384-019-03436-6

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  • DOI: https://doi.org/10.1007/s00384-019-03436-6

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