title: Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery.
abstract: OBJECTIVE
  To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients.
  
  
  METHODS
  Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals.
  
  
  METHODS
  An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality.
  
  
  METHODS
  We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data.
  
  
  RESULTS
  Of 47,459 CRC patients, 6.6 percent died within 30 days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30 days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent).
  
  
  CONCLUSIONS
  Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.
authors.affiliation: Department of Epidemiology, Saint Louis University College for Public Health, 3545 Lafayette Ave, St Louis, MO 63104; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO.
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Min
authors.initials: M
authors.lastname: Lian
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
authors.forename: Anjali D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
authors.forename: Matthew
authors.initials: M
authors.lastname: Mutch
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
authors.forename: Nicholas
authors.initials: N
authors.lastname: Davidson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Colorectal cancer; multilevel; neighborhood; poverty