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Outcomes following colorectal cancer surgery: Results from a population‐based study in Queensland, Australia, using quality indicators
Author(s) -
Theile David E.,
Philpot Shoni,
Blake Michael,
Harrington John,
Youl Philippa H.
Publication year - 2019
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.13087
Subject(s) - medicine , colorectal cancer , logistic regression , population , mortality rate , retrospective cohort study , disease , cancer , emergency medicine , environmental health
Rationale, aims and objectives Colorectal cancer (CRC) is one of the most common cancers diagnosed worldwide, and rates are continuing to rise. Surgery is the primary treatment for CRC, and our aim was to examine clinical outcomes following major resection using a series of established quality indicators and to identify factors associated with poor clinical outcomes. Method This population‐based retrospective study included 4321 patients with diagnosed with CRC in 2012 and 2014 in Queensland, Australia, who underwent a major resection. Primary outcomes included in‐hospital mortality, 30‐day unplanned readmission, extended hospital stay (>21 days), and 30‐ and 90‐day mortality. Multivariable logistic regression modelling was conducted to establish factors independently associated with each outcome of interest. Results Overall, in‐hospital mortality was 1.5%, 3.0% had an unplanned readmission, 8% had an extended hospital stay, and 30‐ and 90‐day postoperative mortality was 1.6% and 3.1%, respectively. After adjustment, we found that factors such as older age, presence of comorbidities, emergency admission, and stoma formation were significantly associated with poorer outcomes with these findings being consistent across each of the outcomes of interest. In addition to these factors, the risk of 90‐day mortality was significantly elevated for patients with advanced stage disease (OR = 1.95, CI 1.35‐2.82). Sex, primary site, hospital volume, residential location, nor socioeconomic status was found to be associated with any of the outcomes of interest. Conclusion Overall, the risk of poorer clinical outcomes for CRC patients in Queensland, Australia, is low. There is however a subgroup of patients at particularly elevated risk of poorer outcomes following CRC. Strategies to reduce the poorer clinical outcomes this group of patients experience should be explored.