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Open Access 01-10-2018 | Original Scientific Report

Hospital Teaching Status and Patients’ Outcomes After Colon Cancer Surgery

Authors: Julia T. van Groningen, Eric H. Eddes, Hans F. J. Fabry, Marc W. A. van Tilburg, Ernst J. van Nieuwenhoven, Yvonne Snel, Perla J. Marang-van de Mheen, Mirre E. de Noo, On behalf of the Dutch Surgical Colorectal Cancer Audit Group and the Co-operating General Hospitals

Published in: World Journal of Surgery | Issue 10/2018

Abstract

Background and objectives

It is increasingly accepted that quality of colon cancer surgery might be secured by combining volume standards with audit implementation. However, debate remains about other structural factors also influencing this quality, such as hospital teaching status. This study evaluates short-term outcomes after colon cancer surgery of patients treated in general, teaching or academic hospitals.

Methods

All patients (n = 23,593) registered in the Dutch Colorectal Audit undergoing colon cancer surgery between 2011 and 2014 were included. Patients were divided into groups based on teaching status of their hospital. Main outcome measures were serious complications, failure to rescue (FTR) and 30-day or in-hospital mortality. Multivariate logistic regression models on these outcome measures and with hospital teaching status as primary determinant were used, adjusted for case-mix, year of surgery and hospital volume.

Results

Patients treated in teaching and academic hospitals showed higher adjusted serious complication rates, compared to patients treated in general hospitals (odds ratio 1.25 95% CI [1.11–1.39] and OR 1.23 [1.05–1.46]). However, patients treated in teaching hospitals had lower adjusted FTR rates than patients treated in general hospitals (OR 0.63 [0.44–0.89]). However, for all outcomes there was considerable between-hospitals variation within each type of teaching status.

Conclusion

On average, patients treated in general hospitals had lower serious complication rates, but patients treated in teaching hospitals had more favorable FTR rates. Given the hospital variation within each hospital teaching type, it is possible to deliver excellent care regardless of the hospital teaching type.

Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108CrossRefPubMed

http://www.cijfersoverkanker.nl. Accessed 2 May 2016

Platell C, Lim D, Tajudeen N et al (2003) Does surgical sub-specialization influence survival in patients with colorectal cancer? World J Gastroenterol 9(5):961–964CrossRefPubMedPubMedCentral

Kolfschoten NE, Marang van de Mheen PJ, Gooiker GA et al (2011) Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands. Eur J Surg Oncol 37(11):956–963CrossRefPubMed

Van Leersum NJ, Snijders HS, Henneman D et al (2013) The Dutch surgical colorectal audit. Eur J Surg Oncol 39(10):1063–1070CrossRefPubMed

Henneman D, van Leersum NJ, Ten Berge M et al (2013) Failure-to-rescue after colorectal cancer surgery and the association with three structural hospital factors. Ann Surg Oncol 20(11):3370–3376CrossRefPubMed

van Gijn W, Gooiker GA, Wouters MWJM et al (2010) Volume and outcome in colorectal cancer surgery. Eur J Surg Oncol 36(Suppl 1):S55–S63CrossRefPubMed

Finks JF, Osborne NH, Brikmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364(22):2128–2137CrossRefPubMedPubMedCentral

Henneman D, Dikken JL, Putter H et al (2014) Centralization of esophagectomy: how far should we go? Ann Surg Oncol 21(13):4068–4074CrossRefPubMed

10.

Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB (2010) Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg 211(3):325–330CrossRefPubMed

11.

Elferink MAG, Wouters MWJM, Krijnen P et al (2010) Disparities in quality of care for colon cancer between hospitals in the Netherlands. Eur J Surg Oncol 36(Suppl 1):S64–S73CrossRefPubMed

12.

Gietelink L, Henneman D, van Leersum NJ et al (2015) The influence of hospital volume on circumferential resection margin involvement: results of the Dutch Surgical Colorectal Audit. Ann Surg 263:745–750CrossRef

13.

Kolfschoten NE, Wouters MW, Gooiker GA et al (2012) Nonelective colon cancer resections in elderly patients: results from the Dutch surgical colorectal audit. Dig Surg 5:412–419CrossRef

14.

Allison JJ (2000) Relationship of hospital teaching status with quality of care and mortality for medicare patients with acute MI. JAMA 284(10):1256CrossRefPubMed

15.

Trinh Q-D, Schmitges J, Sun M et al (2011) Radical prostatectomy at academic versus nonacademic institutions: a population based analysis. J Urol 186(5):1849–1854CrossRefPubMed

16.

Silber JH, Rosenbaum PR, Romano PS et al (2009) Hospital teaching intensity, patient race, and surgical outcomes. Arch Surg 144(2):113–120CrossRefPubMedPubMedCentral

17.

Kupersmith J (2005) Quality of care in teaching hospitals: a literature review. Acad Med 80(5):458–466CrossRefPubMed

18.

Ayanian JZ, Weissman JS (2002) Teaching hospitals and quality of care: a review of the literature. Milbank Q 80(3):569–593CrossRefPubMedPubMedCentral

19.

Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137CrossRefPubMed

20.

Friese CR, Earle CC, Silber JH, Aiken LH (2010) Hospital characteristics, clinical severity, and outcomes for surgical oncology patients. Surgery 147(5):602–609CrossRefPubMedPubMedCentral

21.

Simunovic M, Rempel E, Thériault ME et al (2006) Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg 49(4):251–258PubMedPubMedCentral

22.

Engel AF, Oomen JL, Knol DL, Cuesta MA (2005) Operative mortality after colorectal resection in the Netherlands. Br J Surg 92(12):1526–1532CrossRefPubMed

23.

Johnston MJ, Arora S, King D et al (2015) A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery 157(4):752–763CrossRefPubMed

24.

Di Carlo A, Andtbacka RH, Shrier I et al (2001) The value of specialization-is there an outcome difference in the management of fistulas complicating diverticulitis. Dis Colon Rectum 44(10):1456–1463CrossRefPubMed

25.

Merlino J (2007) Defining the volume–quality debate: is it the surgeon, the center, or the training? Clin Colon Rectal Surg. 20(3):231–236CrossRefPubMedPubMedCentral

Title: Hospital Teaching Status and Patients’ Outcomes After Colon Cancer Surgery
Authors: Julia T. van Groningen
Eric H. Eddes
Hans F. J. Fabry
Marc W. A. van Tilburg
Ernst J. van Nieuwenhoven
Yvonne Snel
Perla J. Marang-van de Mheen
Mirre E. de Noo
On behalf of the Dutch Surgical Colorectal Cancer Audit Group and the Co-operating General Hospitals
Publication date: 01-10-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 10/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4580-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Hospital Teaching Status and Patients’ Outcomes After Colon Cancer Surgery

Abstract

Background and objectives

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background and objectives

Methods

Results

Conclusion

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