M. A. Healy1, H. Yin1, J. D. Birkmeyer2, S. L. Wong1 1University Of Michigan,Surgery, Center For Healthcare Outcomes & Policy,Ann Arbor, MI, USA 2Dartmouth Medical School,Surgery,Lebanon, NH, USA
Introduction: There is wide variation in mortality across hospitals for cancer surgery. While higher rates of mortality are commonly ascribed to high-risk resections, the impact of more common operations is unclear. We sought to evaluate causes of mortality following colon cancer operations across hospitals.
Methods: : 49 American College of Surgeons Commission on Cancer (ACS-CoC) hospitals were selected for participation in a CoC 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 (HMH) and very low mortality (LMH) hospitals (2006-2007).
Results: We identified 3,025 patients who underwent surgery at 25 LMHs (n = 1,391) and 24 HMHs (n = 1,634). There were wide differences in mortality between HMHs and LMHs (9.2% vs. 2.7%). Compared to LMHs, HMHs had more patients who were black (11.2% vs. 6.5%), had >2 comorbidities (22.7% vs. 18.9%), ASA class 4-5 (11.9% vs. 5.3%), and were functionally dependent (13.9% vs. 8.9%; p<.001 for all). For emergency resections, mortality was higher in HMHs versus LMHs (28.3% vs. 11.4%; OR 3.1, 95% CI 1.4-6.7) with ICU admission and prolonged mechanical ventilation more likely in HMHs.
Conclusion: There is significant variation in mortality across hospitals for colon cancer surgery. In emergent cases, perioperative mortality is nearly as high as 1 in 3 patients in HMHs, and many who die undergo ICU admission with mechanical ventilation. This finding reflects a need for improved surgical decision-making to enhance outcomes and quality of care at these hospitals.