title: Safety of elective colorectal cancer surgery: non-surgical complications and colectomies are targets for quality improvement.
abstract: BACKGROUND
  Mortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections.
  
  
  METHODS
  Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011-2012. Severe complication- and FTR rates were compared between the groups in univariate and multivariate analysis.
  
  
  RESULTS
  Colon cancer (CC) patients (n = 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n = 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06-3.37).
  
  
  CONCLUSIONS
  Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non-)surgical complications, especially in colon cancer surgery.
authors: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors: Daniel
authors: D
authors: Henneman
authors: Martijn G
authors: MG
authors: Ten Berge
authors: Heleen S
authors: HS
authors: Snijders
authors: Nicoline J
authors: NJ
authors: van Leersum
authors: Marta
authors: M
authors: Fiocco
authors: Theo
authors: T
authors: Wiggers
authors: Rob A E M
authors: RA
authors: Tollenaar
authors: Michel W J M
authors: MW
authors: Wouters
mesh_terms: D017677:Age Distribution; D000368:Aged; D054869:Clinical Audit; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data*; D003110:Colonic Neoplasms / Q000601:surgery*; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D011787:Quality of Health Care; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000706:statistics & numerical data
keywords: colon cancer; failure to rescue; postoperative complications; postoperative mortality; rectal cancer