Reoperation as a quality indicator in colorectal surgery: a population-based analysis.
OBJECTIVE
To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay.


BACKGROUND
Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored.


METHODS
Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database.


METHODS
sociodemographics, tumor characteristics, comorbidity, and acuity.


METHODS
postoperative procedural intervention.


METHODS
Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures.


RESULTS
A total of 5.8% of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95% confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95% CI = 1.4-1.8), and emergent admission (RR = 1.3; 95% CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95% CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95% CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7%; RR mortality = 2.9; 95% CI = 2.3-3.7), wound complications (21.1%; RR mortality = 0.7; 95% CI = 0.4-1.3), and organ injury (18.7%; RR mortality = 1.6; 95% CI = 1.1-2.3).


CONCLUSIONS
Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.
Morris
Arden M
AM
Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA. ammsurg@umich.edu
Baldwin
Laura-Mae
LM
Matthews
Barbara
B
Dominitz
Jason A
JA
Barlow
William E
WE
Dobie
Sharon A
SA
Billingsley
Kevin G
KG
D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D018426:SEER Program; D012737:Sex Factors; D012959:Socioeconomic Factors