Differences in perioperative care at low- and high-mortality hospitals with cancer surgery.
OBJECTIVE
To evaluate adherence to perioperative processes of care associated with major cancer resections.


BACKGROUND
Mortality rates associated with major cancer resections vary across hospitals. Because mechanisms underlying such variations are not well-established, we studied adherence to perioperative care processes.


METHODS
There were 1,279 hospitals participating in the National Cancer DataBase (2005-2006) ranked on a composite measure of mortality for bladder, colon, esophagus, stomach, lung, and pancreas cancer operations. We sampled hospitals from among those with the lowest and highest mortality rates, with 19 low-mortality hospitals [(LMHs), risk-adjusted mortality rate of 2.84 %] and 30 high-mortality hospitals [(HMHs), risk-adjusted mortality rate of 7.37 %]. We then conducted onsite chart reviews. Using logistic regression, we examined differences in perioperative care, adjusting for patient and tumor characteristics.


RESULTS
Compared to LMHs, HMHs were less likely to use prophylaxis against venous thromboembolism, either preoperative or postoperatively [adjusted relative risk (aRR) 0.74, 95 % CI 0.50-0.92 and aRR 0.80, 95 % CI 0.56-0.93, respectively]. The two hospital groups were indistinguishable with respect to processes aimed at preventing surgical site infections, such as the use of antibiotics prior to incision (aRR, 0.99, 95 % CI 0.90-1.04), and processes intended to prevent cardiac events, including the use of β-blockers (1.00, 95 % CI 0.81-1.14). HMHs were significantly less likely to use epidurals (aRR, 0.57, 95 % CI 0.32-0.93).


CONCLUSIONS
HMHs and LMHs differ in several aspects of perioperative care. These areas may represent opportunities for improving cancer surgery quality at hospitals with high mortality.
Department of Surgery and Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.
Sha'Shonda L
SL
Revels
Sandra L
SL
Wong
Mousumi
M
Banerjee
Huiying
H
Yin
John D
JD
Birkmeyer
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D013503:Surgery Department, Hospital; D015996:Survival Rate