Thirty-day post-operative mortality after colorectal cancer surgery in England


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Eva Morris1, Faye Taylor1, James Thomas1, Phil Quirke1, Paul Finan1, Michel Coleman2, Bernard Rachet2, David Forman1
1University of Leeds, Leeds, United Kingdom,2London School of Hygiene and Tropical Medicine, London, United Kingdom

Background

There is increasing demand for the NHS to publish data on clinical outcomes such as post-operative mortality, by NHS Hospital Trust, to inform patient choice. This study aimed to assess the variation between Hospital Trusts within the English NHS in risk-adjusted 30-day post-operative mortality for colorectal cancer patients

Method

Information on all colorectal cancer patients diagnosed in England between 1998 and 2006 and who underwent a major resection were extracted from the National Cancer Data Repository (NCDR). National patterns of 30-day post-operative mortality were examined and logistic binary regression used to study factors associated with death within 30 days of surgery. Funnel plots were used to show variation between Trusts in risk-adjusted mortality.

Results

160,920 patients underwent a major abdominal surgical procedure for colorectal cancer over the study period. Overall 30-day mortality was 6.7% but decreased over time from 6.8% in 1998 to 5.8% in 2006. Post-operative mortality increased with age (15.1% (95%CI 14.2-16.0%) for those aged over 80), co-morbidity (24.2% (95%CI 21.9-26.5) for those with a Charlson co-morbidity score of 3 or more), stage of disease (9.7% (95%CI 9.0-10.4%) for DukesÂ’ D patients), socio-economic deprivation (7.7% (95%CI 7.1-8.3%) for residents of the most deprived quintile) and operative urgency (15.0% (95%CI 14.2-15.8%) for patients undergoing emergency resection). Risk-adjusted control charts demonstrated that one Trust had consistently significantly better outcomes and three significantly worse outcomes than the population mean

Conclusion

Significant variation in 30-day post-operative mortality following major colorectal cancer surgery existed between NHS hospitals in England throughout the period 1998 to 2006.