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Introduction: Most quality of care studies that have analyzed administrative databases have only been able to examine inpatient mortality—which may be a limitation for procedures whose inpatient mortality rates are low. In response, some researchers have examined longer term mortality outcomes (e.g. 30-day), but the available databases only pertain to non-representative segments of the population (i.e. Medicare patients, or Veterans), or cancer registries. In this study, we use a newly developed database to examine the 1-year mortality rates for two vascular surgery procedures. Importantly, the data is population-based, and therefore generalizable. Methods: The OSHPD database (1995–1999), which reports all California inpatient discharges, was linked to the State Death File in order to study mortality outcomes beyond hospital discharge. CEA and AAA procedures were identified by ICD-9 codes and the rates of inpatient and 1-year mortality were assessed. Analyses were performed for each procedure, as well as for elective and emergent cases. Results: For all CEA procedures (n = 44601), the inpatient and 1-year mortality rates were 0.8% and 5.8%, respectively. For emergent cases, the inpatient and 1-year mortality rates were 1.57% and 9.19% (which represents a 5.8-fold increase), while that for elective cases were 0.5% and 5.4% (a 9.7-fold increase). Finally, the CEA inpatient mortality rate for all patients accounts for only 14% of all CEA deaths at 1 year. For all AAA procedures, (n = 16114), the inpatient and 1-year mortality rates were 12.8% and 18.8%. The inpatient and 1-year mortality rates for emergent cases were 28% and 37.1% (a 1.3-fold increase), while for elective cases, they were 4.5% and 9.7%, respectively (a 2.15-fold increase). Contrary to CEA procedures, the AAA inpatient mortality rate for all-comers accounts for 68% of the AAA deaths at 1 year. Conclusions: Our study uses a novel database linkage and reports inpatient and 1-year mortality rates for two common vascular surgical procedures (i.e. CEA and AAA). This analysis provides meaningful data because of the ability to examine outcomes beyond hospital discharge. Future studies will examine the longer-term mortality rates of other common surgical procedures. [Copyright &y& Elsevier]

Introduction: The overarching goal of the National Cancer Institute is to eliminate death and suffering from all cancers in the next 15 years. Longitudinal analyses of population-based cancer registries allow for meaningful comparisons of epidemiology and survival-related outcomes. In order to assess the quality of US cancer care, this study uses 2 complimentary population-based datasets to report the epidemiology and outcomes of nine surgery-related cancers over the past 3 decades. Methods: Using the SEER cancer database (1973–1999), all patients (>18 y/o) diagnosed with adenocarcinoma of esophagus, stomach, biliary duct, pancreas, small bowel, colon, rectum; esophageal squamous cell carcinoma (ESC), and hepatocellular (HCC) carcinoma (n = 382,032) were analyzed. Changes in incidence rates, stage at presentation (local, regional, distant), and 5-year cancer and stage-specific survivals were determined. The OSHPD database (1990–2000), which reports California inpatient discharges, was concurrently used to evaluate inpatient mortality after surgical resection for each cancer (n = 34,057). Results: Incidence rates increased for 3 cancers (esophageal, HCC, small bowel); decreased for 3 (rectal, stomach, ESC); and stayed constant for 3 (biliary, pancreatic, colon). More patients presented with local/regional disease in the 1990s (compared to 1970s) for 8 tumors (except small bowel, p < 0.05). Five-year overall survival improved for all but small bowel (p < 0.05); and survival for local stage tumors was improved for all cancer types except small bowel and biliary (p < 0.05). Finally, inpatient mortality rates, which can be a proxy for surgical quality and safety, declined significantly for liver, esophageal, pancreatic, and gastric resections (p < 0.05) over the past decade. Conclusions: This report card evaluates longitudinal trends in epidemiology and outcomes for 9 surgery-related cancers and identifies where improvements have been made. Not only does it appear that we are detecting tumors at an earlier and more treatable stage, but also that therapies have become more effective and safe over the past 3 decades. While these findings are encouraging, it highlights the importance of examining longitudinal trends for evaluating outcomes and areas for further study. [Copyright &y& Elsevier]