Open AccessHospital Teaching Status and Patients’ Outcomes After Colon Cancer Surgery
Author(s) -
Groningen Julia T.,
Eddes Eric H.,
Fabry Hans F. J.,
Tilburg Marc W. A.,
Nieuwenhoven Ernst J.,
Snel Yvonne,
Marangvan de Mheen Perla J.,
Noo Mirre E.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-018-4580-3
Subject(s) - medicine , audit , colorectal cancer , odds ratio , logistic regression , cardiothoracic surgery , abdominal surgery , vascular surgery , case mix index , colorectal surgery , complication , cardiac surgery , mortality rate , emergency medicine , general surgery , cancer , surgery , nursing , management , economics
Background and objectives It is increasingly accepted that quality of colon cancer surgery might be secured by combining volume standards with audit implementation. However, debate remains about other structural factors also influencing this quality, such as hospital teaching status. This study evaluates short‐term outcomes after colon cancer surgery of patients treated in general, teaching or academic hospitals. Methods All patients ( n = 23,593) registered in the Dutch Colorectal Audit undergoing colon cancer surgery between 2011 and 2014 were included. Patients were divided into groups based on teaching status of their hospital. Main outcome measures were serious complications, failure to rescue (FTR) and 30‐day or in‐hospital mortality. Multivariate logistic regression models on these outcome measures and with hospital teaching status as primary determinant were used, adjusted for case‐mix, year of surgery and hospital volume. Results Patients treated in teaching and academic hospitals showed higher adjusted serious complication rates, compared to patients treated in general hospitals (odds ratio 1.25 95% CI [1.11–1.39] and OR 1.23 [1.05–1.46]). However, patients treated in teaching hospitals had lower adjusted FTR rates than patients treated in general hospitals (OR 0.63 [0.44–0.89]). However, for all outcomes there was considerable between‐hospitals variation within each type of teaching status. Conclusion On average, patients treated in general hospitals had lower serious complication rates, but patients treated in teaching hospitals had more favorable FTR rates. Given the hospital variation within each hospital teaching type, it is possible to deliver excellent care regardless of the hospital teaching type.