Failure-to-Rescue After Colorectal Cancer Surgery and the Association with Three Structural Hospital Factors
- First Online:
- 426 Downloads
This study was designed to evaluate the association between structural hospital characteristics and failure-to-rescue (FTR) after colorectal cancer surgery. A growing body of evidence suggests a large hospital variation concerning mortality rates in patients with a severe complication (FTR) in colorectal cancer surgery. Which structural hospital factors are associated with better FTR rates remains largely unclear.
All patients undergoing colorectal cancer surgery from 2009 through 2011 in 92 Dutch hospitals were analysed. Univariate and multivariate logistic regression models, including casemix, hospital volume, teaching status, and different levels of intensive care unit (ICU) facilities, were used to analyse risk-adjusted FTR rates.
A total of 25,591 patients from 92 hospitals were included. The FTR rate ranged between 0 and 39 %. In univariate analysis, high hospital volume (>200 vs. ≤200 patients/year), teaching status (academic vs. teaching vs. nonteaching hospitals) and high level of ICU facilities (highest level 3 vs. lowest level 1) were associated with lower FTR rates. Only the higher levels of ICU facilities (2 or 3 compared with level 1) were independently associated with lower failure-to-rescue rates (odds ratio 0.72; 95 % confidence interval 0.65–0.88) in multivariate analysis.
Hospital type and annual hospital volume were not independently associated with FTR rates in colorectal cancer surgery. Instead, the lowest level of ICU facilities was independently associated with higher rates. This suggests that a more advanced ICU may be an important factor that contributes to better failure-to-rescue rates, although individual hospitals perform well with lower ICU levels.
- 4.Henneman D, Snijders HS, Fiocco M, et al. Hospital variation in failure to rescue after colorectal cancer surgery: results of the Dutch Surgical Colorectal Audit. Ann Surg Oncol. 2013. doi:10.1245/s10434-013-2896-7.
- 12.Silber JH, Rosenbaum PR, Romano PS, et al. Hospital teaching intensity, patient race, and surgical outcomes. Arch Surg. 2009;144:113–20; discussion 21.Google Scholar
- 14.Dutch hospital data (DHD)-databank (2012). http://www.ziekenhuizentransparant.nl. Accessed 01 Aug 2012.
- 18.Dutch Society for Anesthesiology. Guidline “Richtlijn organisatie en werkwijze op intensive care-afdelingen voor volwassenen in Nederland.” 2006.Google Scholar
- 25.Ludikhuize J, Hamming A, de Jonge E, Fikkers BG. Rapid response systems in The Netherlands. Jt Comm J Qual Patient Saf. 2011;37:138–44, 197.Google Scholar