Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery

Mario Schootman; Min Lian; Sandi L Pruitt; Anjali D Deshpande; Samantha Hendren; Matthew Mutch; Donna B Jeffe; Nicholas Davidson

doi:10.1111/1475-6773.12171a

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Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery

Journal article

Open access

Peer reviewed

Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery

Mario Schootman, Min Lian, Sandi L Pruitt, Anjali D Deshpande, Samantha Hendren, Matthew Mutch, Donna B Jeffe and Nicholas Davidson

Health services research, Vol.49(4), pp.1145-1164

08/2014

DOI: 10.1111/1475-6773.12171a

PMCID: PMC4111769

PMID: 24673560

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Abstract

To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients. Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals. An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality. We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data. Of 47,459 CRC patients, 6.6 percent died within 30 days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30 days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent). Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.

Colorectal Neoplasms - mortality

Colorectal Neoplasms - surgery

United States - epidemiology

SEER Program

Humans

Logistic Models

Male

Postoperative Complications - mortality

Hospital Mortality - trends

Time Factors

Aged, 80 and over

Cause of Death - trends

Female

Aged

Retrospective Studies

Odds Ratio

Details

Title: Subtitle: Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery
Creators: Mario Schootman - Department of Epidemiology, Saint Louis University College for Public Health, 3545 Lafayette Ave, St Louis, MO 63104; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO
Min Lian
Sandi L Pruitt
Anjali D Deshpande
Samantha Hendren
Matthew Mutch
Donna B Jeffe
Nicholas Davidson
Resource Type: Journal article
Publication Details: Health services research, Vol.49(4), pp.1145-1164
DOI: 10.1111/1475-6773.12171a
PMID: 24673560
PMCID: PMC4111769
NLM abbreviation: Health Serv Res
ISSN: 1475-6773
eISSN: 1475-6773
Publisher: United States
Grant note: K07 CA163665 / NCI NIH HHS R37 HL038180 / NHLBI NIH HHS CA112159 / NCI NIH HHS P30 CA91842 / NCI NIH HHS R01 CA112159 / NCI NIH HHS UL1 TR000448 / NCATS NIH HHS DK-52574 / NIDDK NIH HHS R01 CA137750 / NCI NIH HHS UL1 TR001105 / NCATS NIH HHS P30 CA091842 / NCI NIH HHS R01 DK056260 / NIDDK NIH HHS R01 HL038180 / NHLBI NIH HHS HL-38180 / NHLBI NIH HHS DK-56260 / NIDDK NIH HHS P30 DK052574 / NIDDK NIH HHS
Language: English
Date published: 08/2014
Academic Unit: Epidemiology
Record Identifier: 9983995115902771

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