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Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery
- Source :
- International Journal for Quality in Health Care, 33(1). OXFORD UNIV PRESS, International Journal for Quality in Health Care
- Publication Year :
- 2021
- Publisher :
- Oxford University Press (OUP), 2021.
-
Abstract
- Background Emergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed. Objective To explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery. Methods An observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix. Results Patients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]). Conclusion This study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.
- Subjects :
- Male
medicine.medical_specialty
Colorectal cancer
colon cancer surgery
Logistic regression
law.invention
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
quality of care
law
medicine
Humans
risk factors
AcademicSubjects/MED00860
Original Research Article
Hospital Mortality
business.industry
Health Policy
Medical record
Public Health, Environmental and Occupational Health
General Medicine
Odds ratio
Perioperative
medicine.disease
Intensive care unit
Hospitals
Confidence interval
Surgery
Hospitalization
Intensive Care Units
030220 oncology & carcinogenesis
Colonic Neoplasms
Female
030211 gastroenterology & hepatology
Complication
business
Subjects
Details
- ISSN :
- 14643677 and 13534505
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- International Journal for Quality in Health Care
- Accession number :
- edsair.doi.dedup.....538e0dd3d4d1f4131c82a630b4e8d257