Hospital variability in postoperative mortality after rectal cancer surgery in the Spanish Association of Surgeons project: The impact of hospital volume

Autores de IIS La Fe

• Eduardo García-Granero Ximénez

  Autor

Participantes ajenos a IIS La Fe

• Ortiz H
• Biondo S
• Codina A
• Ciga MÁ
• Enríquez-Navascués JM
• Espín E
• Roig JV

Grupos

• Enfermedad Inflamatoria Intestinal

  

  Leader

  Pilar Nos Mateu

Abstract

Objective: This multicentre observational study examines variation between hospitals in postoperative mortality after elective surgery in the Rectal Cancer Project of the Spanish Society of Surgeons and explores whether hospital volume and patient characteristics contribute to any variation between hospitals. Methods: Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all rectal adenocarcinomas operated by an anterior resection or an abdominoperineal excision at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, tumour location and stage, administration of neoadjuvant treatment, and annual volume of surgical procedures. Results: A total of 9809 consecutive patients were included. The rate of 30-day postoperative mortality was 1.8% Stratified by annual surgical volume hospitals varied from 1.4 to 2.0 in 30day mortality. In the multilevel regression analysis, male gender (OR 1.623 [1.143; 2.348]; P<.008), increased age (OR: 5.811 [3.479; 10.087]; P<.001), and ASA score (OR 10.046 [3.390; 43.185]; P<.001) were associated with 30-day mortality. However, annual surgical volume was not associated with mortality (OR 1.309 [0.483; 4.238]; P=.619). Besides, there was a statistically significant variation in mortality between all departments (MOR 1.588 [1.293; 2.015]; P<.001). Conclusion: Postoperative mortality varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume. (C) 2015 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Rectal cancer; 30-day mortality; Comparison of departments; Case-mix; Multicentre database; Education