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Hospital and Geographic Variability in Two Colorectal Cancer Surgery Outcomes: Complications and Mortality After Complications

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to describe hospital and geographic variation in 30-day risk of surgical complications and death among colorectal cancer (CRC) patients and the extent to which patient-, hospital-, and census-tract-level characteristics increased risk of these outcomes.

Methods

We included patients at least 66 years old with first primary stage I–III CRC from the 2000–2005 National Cancer Institute’s Surveillance, Epidemiology, and End Results data linked with 1999–2005 Medicare claims. A multilevel, cross-classified logistic model was used to account for nesting of patients within hospitals and within residential census tracts. Outcomes were risk of complications and death after a complication within 30 days of surgery.

Results

Data were analyzed for 35,946 patients undergoing surgery at 1,222 hospitals and residing in 12,187 census tracts; 27.2 % of patients developed complications, and of these 13.4 % died. Risk-adjusted variability in complications across hospitals and census tracts was similar. Variability in mortality was larger than variability in complications, across hospitals and across census tracts. Specific characteristics increased risk of complications (e.g., census-tract-poverty rate, emergency surgery, and being African-American). No hospital characteristics increased complication risk. Specific characteristics increased risk of death (e.g. census-tract-poverty rate, being diagnosed with colon (versus rectal) cancer, and emergency surgery), while hospitals with at least 500 beds showed reduced death risk.

Conclusions

Large, unexplained variations exist in mortality after surgical complications in CRC across hospitals and geographic areas. The potential exists for quality improvement efforts targeted at the hospital and/or census-tract levels to prevent complications and augment hospitals’ ability to reduce mortality risk.

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Acknowledgment

This work was supported by grants from the National Cancer Institute at the National Institutes of Health (Grant No. CA112159); and the Health Behavior, Communication and Outreach Core; the Core is supported in part by the National Cancer Institute Cancer Center Support Grant (Grant No. P30 CA91842) to the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. Dr. Davidson was supported in part through grants HL-38180, DK-56260, and Digestive Disease Research Core Center DK-52574. We gratefully acknowledge James Struthers for his data management and programming services. We thank the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri, for the use of the Health Behavior, Communication, and Outreach Core. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

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Authors and Affiliations

  1. Department of Epidemiology, Saint Louis University, Saint Louis, MO, USA

    M. Schootman PhD

  2. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA

    M. Schootman PhD, M. Mutch MD, A. D. Deshpande PhD, D. B. Jeffe PhD & N. O. Davidson MD

  3. Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA

    M. Lian MD, PhD, A. D. Deshpande PhD & D. B. Jeffe PhD

  4. Department of Clinical Sciences, University of Texas – Southwestern Medical Center, Dallas, TX, USA

    S. L. Pruitt PhD

  5. Harold C. Simmons Cancer Center, Dallas, TX, USA

    S. L. Pruitt PhD

  6. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    S. Hendren MD, MPH

  7. Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA

    M. Mutch MD

  8. Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA

    N. O. Davidson MD

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  1. M. Schootman PhD
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Correspondence to M. Schootman PhD.

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Schootman, M., Lian, M., Pruitt, S.L. et al. Hospital and Geographic Variability in Two Colorectal Cancer Surgery Outcomes: Complications and Mortality After Complications. Ann Surg Oncol 21, 2659–2666 (2014). https://doi.org/10.1245/s10434-013-3472-x

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  • DOI: https://doi.org/10.1245/s10434-013-3472-x

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