title: Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands.
abstract: OBJECTIVE
  The purpose of this study was to determine how expected mortality based on case-mix varies between colorectal cancer patients treated in non-teaching, teaching and university hospitals, or high, intermediate and low-volume hospitals in the Netherlands.
  
  
  METHODS
  We used the database of the Dutch Surgical Colorectal Audit 2010. Factors predicting mortality after colon and rectum carcinoma resections were identified using logistic regression models. Using these models, expected mortality was calculated for each patient.
  
  
  RESULTS
  8580 patients treated in 90 hospitals were included in the analysis. For colon carcinoma, hospitals' expected mortality ranged from 1.5 to 14%. Average expected mortality was lower in patients treated in high-volume hospitals than in low-volume hospitals (5.0 vs. 4.3%, p < 0.05). For rectum carcinoma, hospitals expected mortality varied from 0.5 to 7.5%. Average expected mortality was higher in patients treated in non-teaching and teaching hospitals than in university hospitals (2.7 and 2.3 vs. 1.3%, p < 0.01). Furthermore, rectum carcinoma patients treated in high-volume hospitals had a higher expected mortality than patients treated in low-volume hospitals (2.6 vs. 2.2% p < 0.05). We found no differences in risk-adjusted mortality.
  
  
  CONCLUSIONS
  High-risk patients are not evenly distributed between hospitals. Using the expected mortality as an integrated measure for case-mix can help to gain insight in where high-risk patients go. The large variation in expected mortality between individual hospitals, hospital types and volume groups underlines the need for risk-adjustment when comparing hospital performances.
authors.affiliation: Leiden University Medical Centre, Dept of Surgery, The Netherlands.
authors.forename: N E
authors.initials: NE
authors.lastname: Kolfschoten
authors.forename: P J
authors.initials: PJ
authors.lastname: Marang van de Mheen
authors.forename: G A
authors.initials: GA
authors.lastname: Gooiker
authors.forename: E H
authors.initials: EH
authors.lastname: Eddes
authors.forename: J
authors.initials: J
authors.lastname: Kievit
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000706:statistics & numerical data*