BACKGROUND: Mortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections. METHODS: Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011-2012. Severe complication- and FTR rates were compared between the groups in univariate and multivariate analysis. RESULTS: Colon cancer (CC) patients (n = 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n = 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06-3.37). CONCLUSIONS: Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non-)surgical complications, especially in colon cancer surgery.
BACKGROUND: Mortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections. METHODS: Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011-2012. Severe complication- and FTR rates were compared between the groups in univariate and multivariate analysis. RESULTS:Colon cancer (CC) patients (n = 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n = 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06-3.37). CONCLUSIONS: Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non-)surgical complications, especially in colon cancer surgery.
Authors: Max P L van der Sijp; Esther Bastiaannet; Wilma E Mesker; Lydia G M van der Geest; Anne J Breugom; Willem H Steup; Andreas W K S Marinelli; Larissa N L Tseng; Rob A E M Tollenaar; Cornelis J H van de Velde; J W T Dekker Journal: Int J Colorectal Dis Date: 2016-08-06 Impact factor: 2.571
Authors: Julia Tessa van Groningen; Perla J Marang-van de Mheen; Daniel Henneman; Geerard L Beets; Michel W J M Wouters Journal: BMJ Open Date: 2019-09-24 Impact factor: 2.692
Authors: N C A Vermeer; M P M de Neree Tot Babberich; P Fockens; I D Nagtegaal; C J H van de Velde; E Dekker; P J Tanis; K C M J Peeters Journal: BJS Open Date: 2019-07-30
Authors: Daniëlle D Huijts; Jan Willem T Dekker; Leti van Bodegom-Vos; Julia T van Groningen; Esther Bastiaannet; Perla J Marang-van de Mheen Journal: Int J Qual Health Care Date: 2021-03-11 Impact factor: 2.038