title: Causes of high mortality in colorectal surgery: a review of episodes of care in Veterans Affairs hospitals.
abstract: BACKGROUND
  The episode of care for colorectal surgery in 8 outlier Veterans Affairs Hospitals with high mortality and the volume outcome relationship in 118 Hospitals are examined.
  
  
  METHODS
  A total of 103 deaths were reviewed. Mean age was 74 with 63% of the patients undergoing emergency surgery; 54% of the patients had malignant disease and 21% had metastatic disease.
  
  
  RESULTS
  Nineteen percent of the patients had a delay in diagnosis, 22% had delay in surgery and 14% should have received a different surgery usually less radical. In addition, system related issues were identified in 19% of the cases and practitioner related issues in 20% of the cases. The Spearman rank correlation between colorectal surgery volume and unadjusted mortality was 0.114 (P = 0.22).
  
  
  CONCLUSIONS
  Colorectal surgery death is prevalent in elderly patients undergoing emergency surgery for malignancy or metastatic disease and is not related to hospital volume. Timely diagnosis, less radical surgery while optimizing system based pathways might improve outcome.
authors.affiliation: Boston Veterans Affairs Health Care System, 1400 VFW Parkway, West Roxbury, MA 02132, USA. kitani@med.va.gov
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Robin
authors.initials: R
authors.lastname: Denwood
authors.forename: Tracy
authors.initials: T
authors.lastname: Schifftner
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Joehl
authors.forename: Creighton
authors.initials: C
authors.lastname: Wright
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Ralph G
authors.initials: RG
authors.lastname: DePalma
mesh_terms: D000368:Aged; D003082:Colectomy / Q000401:mortality*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D004638:Emergency Treatment / Q000401:mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery; D011787:Quality of Health Care; D013997:Time Factors; D014481:United States