title: Incidence and determinants of 1-month mortality after cancer-directed surgery.
abstract: BACKGROUND
  Death within 1 month of surgery is considered treatment related and serves as an important health care quality metric. We sought to identify the incidence of and factors associated with 1-month mortality after cancer-directed surgery.
  
  
  METHODS
  We used the Surveillance, Epidemiology and End Results Program to study a cohort of 1 110 236 patients diagnosed from 2004 to 2011 with cancers that are among the 10 most common or most fatal who received cancer-directed surgery. Multivariable logistic regression analyses were used to identify factors associated with 1-month mortality after cancer-directed surgery.
  
  
  RESULTS
  A total of 53 498 patients (4.8%) died within 1 month of cancer-directed surgery. Patients who were married, insured, or who had a top 50th percentile income or educational status had lower odds of 1-month mortality from cancer-directed surgery {[adjusted odds ratio (AOR) 0.80; 95% confidence interval (CI) 0.79-0.82; P < 0.001], (AOR 0.88; 95% CI 0.82-0.94; P < 0.001), (AOR 0.95; 95% CI 0.93-0.97; P < 0.001), and (AOR 0.98; 95% CI 0.96-0.99; P = 0.043), respectively}. Patients who were non-white minority, male, or older (per year increase), or who had advanced tumor stage 4 disease all had a higher risk of 1-month mortality after cancer-directed surgery, with AORs of 1.13 (95% CI 1.11-1.15), P < 0.001; 1.11 (95% CI 1.08-1.13), P < 0.001; 1.02 (95% 1.02-1.03), P < 0.001; and 1.89 (95% CI 1.82-1.95), P < 0.001 respectively.
  
  
  CONCLUSIONS
  Unmarried, uninsured, non-white, male, older, less educated, and poorer patients were all at a significantly higher risk for death within 1 month of cancer-directed surgery. Efforts to reduce 1-month surgical mortality and eliminate sociodemographic disparities in this adverse outcome could significantly improve survival among patients with cancer.
authors.affiliation: Department of Medical Oncology, Harvard Medical School.
authors.forename: B A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Harvard School of Dental Medicine.
authors.forename: G
authors.initials: G
authors.lastname: Inverso
authors.affiliation: Department of Radiation Oncology.
authors.forename: A A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: Department of Medical Oncology, Harvard Medical School.
authors.forename: D R
authors.initials: DR
authors.lastname: Ziehr
authors.affiliation: Department of Radiation Oncology.
authors.forename: A S
authors.initials: AS
authors.lastname: Hyatt
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston.
authors.forename: T K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: K E
authors.initials: KE
authors.lastname: Hoffman
authors.affiliation: Department of Urology, UCLA Medical Center, Los Angeles.
authors.forename: J C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Radiation Oncology.
authors.forename: C J
authors.initials: CJ
authors.lastname: Beard
authors.affiliation: Department of Radiation Oncology.
authors.forename: A V
authors.initials: AV
authors.lastname: D'Amico
authors.affiliation: Department of Radiation Oncology.
authors.forename: N E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Department of Radiation Oncology.
authors.forename: P F
authors.initials: PF
authors.lastname: Orio
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
authors.forename: Q-D
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Radiation Oncology pnguyen@lroc.harvard.edu.
authors.forename: P L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors
keywords: SEER program; health policy; mortality rate; outcomes research; socioeconomic disparities; surgery