Colon cancer operations at high- and low-mortality hospitals.
There is wide variation in mortality across hospitals for cancer operations. While higher rates of mortality are commonly ascribed to high-risk resections, the impact on more common operations is unclear. We sought to evaluate causes of mortality following colon cancer operations across hospitals.



Forty-nine American College of Surgeons Commission on Cancer hospitals were selected for participation in a Commission on Cancer special study. We ranked hospitals using a composite measure of mortality and performed onsite chart reviews. We examined patient characteristics and mortality following colon resections at very high-mortality and very low- mortality hospitals (2006-2007).



We identified 3,025 patients who underwent an operation at 19 low-mortality (n = 1,006) and 30 high-mortality (n = 2,019) hospitals. There were wide differences in risk-adjusted mortality between high-mortality and low-mortality hospitals (9.3% vs 2.4%; P < .001). Compared with low-mortality hospitals, high-mortality hospitals had more patients who were black (11.2% vs 6.5%; P < .001), had ≥2 comorbidities (22.7% vs 18.9%; P < .05), were categorized American Society of Anesthesiologists class 4-5 (11.9% vs 5.3%; P < .001), and were functionally dependent (13.9% vs 8.8%; P < .001). Rates of complication were similar in high-mortality versus low-mortality hospitals (odds ratio 1.29, 95% confidence interval, 0.85-1.95). For those experiencing complications, though, case fatality rates were significantly higher in high-mortality versus low-mortality hospitals (odds ratio 3.74, 95% confidence interval, 1.59-8.82).



There is significant variation in mortality across hospitals for colon cancer operations, despite similar perioperative morbidity. This finding reflects a need for improved operative decision-making to enhance outcomes and quality of care at these hospitals.
Department of Surgery, University of Michigan Health System, Ann Arbor, MI. Electronic address: healym@umich.edu.
Mark A
MA
Healy
Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Tyler R
TR
Grenda
Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Pasithorn A
PA
Suwanabol
Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Huiying
H
Yin
Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Amir A
AA
Ghaferi
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
John D
JD
Birkmeyer
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Sandra L
SL
Wong
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D020379:Risk Adjustment; D015996:Survival Rate; D014481:United States