Classifying cause of death after cancer surgery

A retrospective, single-center study was conducted to understand variation in mortality after elective cancer surgery. Fifty-two patients who died perioperatively after elective cancer resections (colon, esophageal, pancreatic, lung, gastric and liver) were identified. A methodology was developed and used during medical record review to capture the occurrence and chronology of 21 postoperative complications. Data were reviewed by 3 attending surgeons who assigned cause of death based on information from the entire clinical record. This methodology demonstrated good construct validity, with 81% agreement between cause of death assigned by expert review of data from the instrument and that assigned by expert review of the clinical records (kappa = 0.75, P < .005). Cause-specific mortality can be reliably and systematically measured after cancer surgery. Understanding variation in cause-specific mortality can inform future quality improvement efforts.