Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery

Area of Science:

• Healthcare Quality
• Surgical Outcomes
• Public Health Reporting

Background:

• Public reporting of surgical mortality is increasing as a measure of quality.
• This study compares 90-day post-colorectal surgery mortality outlier status with 30-day and longer intervals.
• Understanding temporal trends in mortality reporting is crucial for accurate quality assessment.

Purpose of the Study:

• To compare 90-day mortality outlier status with 30-day and other perioperative intervals.
• To evaluate the utility of 90-day mortality as a preferred indicator for colorectal surgery outcomes.
• To inform public reporting strategies for surgical quality.

Main Methods:

• Analysis of administrative data for adult colorectal resections in English NHS Trusts (April 2001-February 2007).
• Creation of funnel plots for 30, 90, 180, and 365-day post-operative mortality rates.
• Definition of high/low mortality units based on 90-day mortality outlier status.

Main Results:

• 171,688 patients from 153 NHS Trusts were included.
• Mortality rates were 8.5% (30-day), 11.3% (90-day), 13.9% (180-day), and 18.5% (365-day).
• Ninety-day mortality strongly correlated with 180-day (r=0.957) and 365-day (r=0.860) mortality.

Conclusions:

• Extending reporting to 90 days identifies more mortality outliers than 30-day rates.
• Ninety-day mortality is proposed as a preferred indicator for perioperative outcome analysis.
• This approach enhances the identification of variations in surgical quality for public reporting.