Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3370–3376

Failure-to-Rescue After Colorectal Cancer Surgery and the Association with Three Structural Hospital Factors

  • D. Henneman
  • N. J. van Leersum
  • M. ten Berge
  • H. S. Snijders
  • M. Fiocco
  • T. Wiggers
  • R. A. E. M. Tollenaar
  • M. W. J. M. Wouters
Healthcare Policy and Outcomes



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.


  1. 1.
    Silber JH, Rosenbaum PR, Schwartz JS, Ross RN, Williams SV. Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery. JAMA. 1995;274:317–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Ghaferi AA, Dimick JB. Variation in mortality after high-risk cancer surgery: failure to rescue. Surg Oncol Clin N Am. 2012;21:389–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Almoudaris AM, Burns EM, Mamidanna R, et al. Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection. Br J Surg. 2011;98:1775–83.PubMedCrossRefGoogle Scholar
  4. 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.
  5. 5.
    van Gijn W, Gooiker GA, Wouters MW, Post PN, Tollenaar RA, van de Velde CJ. Volume and outcome in colorectal cancer surgery. Eur J Surg Oncol. 2010;36(Suppl 1):S55–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care. 2011;49:1076–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Trinh QD, Schmitges J, Sun M, et al. Radical prostatectomy at academic versus nonacademic institutions: a population based analysis. J Urol. 2011;186:1849–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Bianchi M, Trinh QD, Sun M, et al. Impact of academic affiliation on radical cystectomy outcomes in North America: a population-based study. Can Urol Assoc J. 2012;6:245–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Polanczyk CA, Lane A, Coburn M, Philbin EF, Dec GW, DiSalvo TG. Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state. Am J Med. 2002;112:255–61.PubMedCrossRefGoogle Scholar
  10. 10.
    Allison JJ, Kiefe CI, Weissman NW, et al. Relationship of hospital teaching status with quality of care and mortality for medicare patients with acute MI. JAMA. 2000;284:1256–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg. 2010;211:325–30.PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Dutch hospital data (DHD)-databank (2012). Accessed 01 Aug 2012.
  15. 15.
    Schouten LJ, Jager JJ, van den Brandt PA. Quality of cancer registry data: a comparison of data provided by clinicians with those of registration personnel. Br J Cancer. 1993;68:974–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Schouten LJ, Straatman H, Kiemeney LA, Gimbrere CH, Verbeek AL. The capture-recapture method for estimation of cancer registry completeness: a useful tool? Int J Epidemiol. 1994;23:1111–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Kolfschoten NE, Marang van de Mheen PJ, Gooiker GA, et al. Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands. Eur J Surg Oncol. 2011;37:956–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Dutch Society for Anesthesiology. Guidline “Richtlijn organisatie en werkwijze op intensive care-afdelingen voor volwassenen in Nederland.” 2006.Google Scholar
  19. 19.
    Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, et al. Effects of a medical intensivist on patient care in a community teaching hospital. Mayo Clin Proc. 1997;72:391–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Blunt MC, Burchett KR. Out-of-hours consultant cover and case-mix-adjusted mortality in intensive care. Lancet. 2000;356:735–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Kolfschoten NE, van Leersum NJ, Gooiker GA, et al. Successful and safe introduction of laparoscopic colorectal cancer surgery in Dutch hospitals. Ann Surg. 2013;257(5):916–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Taenzer AH, Pyke JB, McGrath SP. A review of current and emerging approaches to address failure-to-rescue. Anesthesiology. 2011;115:421–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Silber JH, Romano PS, Rosen AK, Wang Y, Even-Shoshan O, Volpp KG. Failure-to-rescue: comparing definitions to measure quality of care. Med Care. 2007;45:918–25.PubMedCrossRefGoogle Scholar
  24. 24.
    Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg. 1999;189:554–9.PubMedCrossRefGoogle Scholar
  25. 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

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • D. Henneman
    • 1
  • N. J. van Leersum
    • 1
  • M. ten Berge
    • 1
  • H. S. Snijders
    • 1
  • M. Fiocco
    • 2
  • T. Wiggers
    • 3
  • R. A. E. M. Tollenaar
    • 1
  • M. W. J. M. Wouters
    • 4
  1. 1.Department of Surgery, K-6Leiden University Medical CenterLeidenThe Netherlands
  2. 2.Department of Medical StatisticsLeiden University Medical CenterLeidenThe Netherlands
  3. 3.Department of SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
  4. 4.Department of Surgical OncologyNational Cancer Institute (NKI)—Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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