Complete state-wide outcomes in elective colon cancer surgery

Area of Science:

• Surgical Quality Improvement
• Health Services Research
• Oncology Outcomes

Background:

• High standards in colon cancer surgery necessitate quality indicator measurement and resource reallocation.
• State-wide administrative data can be used to assess inpatient mortality and compare hospital rates for elective colon cancer surgery.

Purpose of the Study:

• To determine inpatient mortality rates for elective colon cancer surgery in Victoria.
• To compare individual hospital rates and identify variations in outcomes.

Main Methods:

• Utilized the Dr Foster Quality Investigator Tool and the Victorian Admitted Episodes Dataset (2012-2016).
• Measured inpatient mortality, 30-day readmission rates, and length of stay.
• Employed risk-adjusted rates for public vs. private hospital comparisons and funnel plots for inter-hospital variation analysis.

Main Results:

• 6120 colectomies for colon cancer were performed; crude inpatient mortality was 1.3%.
• Public hospitals had significantly higher mortality than private hospitals, even after risk adjustment.
• Lowest volume hospitals demonstrated significantly higher inpatient mortality rates.

Conclusions:

• State-wide data capture reveals low inpatient mortality for elective colon cancer surgery in Victoria.
• Inter-hospital variation, outlier definition, and public vs. private hospital outcome comparisons present ongoing challenges.
• Further development of quality indicators using administrative data is crucial for auditing colon cancer care quality.