Reoperation as a quality indicator in colorectal surgery: A population-based analysis

Arden M. Morris, Laura Mae Baldwin, Barbara Matthews, Jason A. Dominitz, William E. Barlow, Sharon A. Dobie, Kevin Billingsley

    Research output: Contribution to journalArticle

    90 Citations (Scopus)

    Abstract

    OBJECTIVE: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay. SUMMARY BACKGROUND: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored. METHODS: Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database. Independent variables: sociodemographics, tumor characteristics, comorbidity, and acuity. Primary outcome: postoperative procedural intervention. Analysis: Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures. RESULTS: A total of 5.8% of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95% confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95% CI = 1.4-1.8), and emergent admission (RR = 1.3; 95% CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95% CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95% CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7%; RR mortality = 2.9; 95% CI = 2.3-3.7), wound complications (21.1%; RR mortality = 0.7; 95% CI = 0.4-1.3), and organ injury (18.7%; RR mortality = 1.6; 95% CI = 1.1-2.3). CONCLUSIONS: Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.

    Original languageEnglish (US)
    Pages (from-to)73-79
    Number of pages7
    JournalAnnals of Surgery
    Volume245
    Issue number1
    DOIs
    StatePublished - Jan 2007

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    Colorectal Surgery
    Reoperation
    Postoperative Care
    Confidence Intervals
    Population
    Mortality
    Colorectal Neoplasms
    Hospitalization
    Outcome Assessment (Health Care)
    Quality of Health Care
    Wounds and Injuries
    Medicare
    Quality Improvement
    Comorbidity
    Length of Stay
    Cohort Studies
    Logistic Models
    Databases

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Morris, A. M., Baldwin, L. M., Matthews, B., Dominitz, J. A., Barlow, W. E., Dobie, S. A., & Billingsley, K. (2007). Reoperation as a quality indicator in colorectal surgery: A population-based analysis. Annals of Surgery, 245(1), 73-79. https://doi.org/10.1097/01.sla.0000231797.37743.9f

    Reoperation as a quality indicator in colorectal surgery : A population-based analysis. / Morris, Arden M.; Baldwin, Laura Mae; Matthews, Barbara; Dominitz, Jason A.; Barlow, William E.; Dobie, Sharon A.; Billingsley, Kevin.

    In: Annals of Surgery, Vol. 245, No. 1, 01.2007, p. 73-79.

    Research output: Contribution to journalArticle

    Morris, AM, Baldwin, LM, Matthews, B, Dominitz, JA, Barlow, WE, Dobie, SA & Billingsley, K 2007, 'Reoperation as a quality indicator in colorectal surgery: A population-based analysis', Annals of Surgery, vol. 245, no. 1, pp. 73-79. https://doi.org/10.1097/01.sla.0000231797.37743.9f
    Morris AM, Baldwin LM, Matthews B, Dominitz JA, Barlow WE, Dobie SA et al. Reoperation as a quality indicator in colorectal surgery: A population-based analysis. Annals of Surgery. 2007 Jan;245(1):73-79. https://doi.org/10.1097/01.sla.0000231797.37743.9f
    Morris, Arden M. ; Baldwin, Laura Mae ; Matthews, Barbara ; Dominitz, Jason A. ; Barlow, William E. ; Dobie, Sharon A. ; Billingsley, Kevin. / Reoperation as a quality indicator in colorectal surgery : A population-based analysis. In: Annals of Surgery. 2007 ; Vol. 245, No. 1. pp. 73-79.
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    abstract = "OBJECTIVE: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay. SUMMARY BACKGROUND: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored. METHODS: Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database. Independent variables: sociodemographics, tumor characteristics, comorbidity, and acuity. Primary outcome: postoperative procedural intervention. Analysis: Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures. RESULTS: A total of 5.8{\%} of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95{\%} confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95{\%} CI = 1.4-1.8), and emergent admission (RR = 1.3; 95{\%} CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95{\%} CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95{\%} CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7{\%}; RR mortality = 2.9; 95{\%} CI = 2.3-3.7), wound complications (21.1{\%}; RR mortality = 0.7; 95{\%} CI = 0.4-1.3), and organ injury (18.7{\%}; RR mortality = 1.6; 95{\%} CI = 1.1-2.3). CONCLUSIONS: Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.",
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    AU - Morris, Arden M.

    AU - Baldwin, Laura Mae

    AU - Matthews, Barbara

    AU - Dominitz, Jason A.

    AU - Barlow, William E.

    AU - Dobie, Sharon A.

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    N2 - OBJECTIVE: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay. SUMMARY BACKGROUND: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored. METHODS: Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database. Independent variables: sociodemographics, tumor characteristics, comorbidity, and acuity. Primary outcome: postoperative procedural intervention. Analysis: Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures. RESULTS: A total of 5.8% of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95% confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95% CI = 1.4-1.8), and emergent admission (RR = 1.3; 95% CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95% CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95% CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7%; RR mortality = 2.9; 95% CI = 2.3-3.7), wound complications (21.1%; RR mortality = 0.7; 95% CI = 0.4-1.3), and organ injury (18.7%; RR mortality = 1.6; 95% CI = 1.1-2.3). CONCLUSIONS: Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.

    AB - OBJECTIVE: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay. SUMMARY BACKGROUND: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored. METHODS: Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database. Independent variables: sociodemographics, tumor characteristics, comorbidity, and acuity. Primary outcome: postoperative procedural intervention. Analysis: Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures. RESULTS: A total of 5.8% of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95% confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95% CI = 1.4-1.8), and emergent admission (RR = 1.3; 95% CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95% CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95% CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7%; RR mortality = 2.9; 95% CI = 2.3-3.7), wound complications (21.1%; RR mortality = 0.7; 95% CI = 0.4-1.3), and organ injury (18.7%; RR mortality = 1.6; 95% CI = 1.1-2.3). CONCLUSIONS: Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.

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