Failure to rescue in postoperative patients with colon cancer: time to rethink where you get surgery

Viraj Pandit, Faisal Jehan, Muhammad Zeeshan, Jenna Elaine Koblinski, Carolina Martinez, Muhammad Khan, Odinaka P. Mogor, Valentine N Nfonsam

Research output: Contribution to journalArticle

Abstract

Background: Failure to rescue (FTR) is an important measure of quality of care. The aim of this study was to assess FTR in patients with colon cancer (CC) who underwent surgical resection. We hypothesized that patient managed in urban centers had lower FTR. Methods: We performed a 1-y (2011) retrospective analysis of the National Inpatient Sample database and identified all patients with CC who underwent surgical management. Patients were stratified based on the location of treatment: urban versus rural. Outcome measure was FTR, which was defined as death after major complications. Regression analysis was performed to evaluate the independent predictors of FTR. Results: A total of 49,789 patients with CC who underwent surgery were analyzed. The mean age was 71 ± 20.2 y and 59% were males. About 21.5% patients developed in-hospital complications. The overall rates of complications, mortality, and FTR were 21.5%, 3.0%, and 33.8% respectively. Patient managed in rural centers had higher FTR compared with urban centers (39.5% versus 30.1%, P = 0.01). On regression analysis after controlling for age, gender, type of procedure, Charlson Comorbidity Index, and insurance status, management in rural center was independently associated with FTR (odds ratio: 1.9 [1.4-3.7]). On subanalysis of urban centers, management in teaching urban hospital was independently associated with higher FTR (odds ratio: 1.4 [1.2-3.8]). Conclusions: Disparities exist among centers managing patients with CC undergoing surgical intervention. Rural centers have higher FTR compared with similar cohort of patients managed in urban centers. Teaching urban hospital performed worse than nonteaching urban centers. Understanding the reason for these differences may help standardize care across centers and help improve patient outcomes.

LanguageEnglish (US)
Pages1-6
Number of pages6
JournalJournal of Surgical Research
Volume234
DOIs
StatePublished - Feb 1 2019

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Colonic Neoplasms
Urban Hospitals
Teaching Hospitals
Odds Ratio
Regression Analysis
Insurance Coverage
Quality of Health Care
Comorbidity
Inpatients
Outcome Assessment (Health Care)
Databases
Mortality

Keywords

  • Colectomy
  • Colon cancer
  • FTR
  • Urban versus rural

ASJC Scopus subject areas

  • Surgery

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Failure to rescue in postoperative patients with colon cancer : time to rethink where you get surgery. / Pandit, Viraj; Jehan, Faisal; Zeeshan, Muhammad; Koblinski, Jenna Elaine; Martinez, Carolina; Khan, Muhammad; Mogor, Odinaka P.; Nfonsam, Valentine N.

In: Journal of Surgical Research, Vol. 234, 01.02.2019, p. 1-6.

Research output: Contribution to journalArticle

Pandit, Viraj ; Jehan, Faisal ; Zeeshan, Muhammad ; Koblinski, Jenna Elaine ; Martinez, Carolina ; Khan, Muhammad ; Mogor, Odinaka P. ; Nfonsam, Valentine N. / Failure to rescue in postoperative patients with colon cancer : time to rethink where you get surgery. In: Journal of Surgical Research. 2019 ; Vol. 234. pp. 1-6.
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abstract = "Background: Failure to rescue (FTR) is an important measure of quality of care. The aim of this study was to assess FTR in patients with colon cancer (CC) who underwent surgical resection. We hypothesized that patient managed in urban centers had lower FTR. Methods: We performed a 1-y (2011) retrospective analysis of the National Inpatient Sample database and identified all patients with CC who underwent surgical management. Patients were stratified based on the location of treatment: urban versus rural. Outcome measure was FTR, which was defined as death after major complications. Regression analysis was performed to evaluate the independent predictors of FTR. Results: A total of 49,789 patients with CC who underwent surgery were analyzed. The mean age was 71 ± 20.2 y and 59{\%} were males. About 21.5{\%} patients developed in-hospital complications. The overall rates of complications, mortality, and FTR were 21.5{\%}, 3.0{\%}, and 33.8{\%} respectively. Patient managed in rural centers had higher FTR compared with urban centers (39.5{\%} versus 30.1{\%}, P = 0.01). On regression analysis after controlling for age, gender, type of procedure, Charlson Comorbidity Index, and insurance status, management in rural center was independently associated with FTR (odds ratio: 1.9 [1.4-3.7]). On subanalysis of urban centers, management in teaching urban hospital was independently associated with higher FTR (odds ratio: 1.4 [1.2-3.8]). Conclusions: Disparities exist among centers managing patients with CC undergoing surgical intervention. Rural centers have higher FTR compared with similar cohort of patients managed in urban centers. Teaching urban hospital performed worse than nonteaching urban centers. Understanding the reason for these differences may help standardize care across centers and help improve patient outcomes.",
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AU - Martinez, Carolina

AU - Khan, Muhammad

AU - Mogor, Odinaka P.

AU - Nfonsam, Valentine N

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AB - Background: Failure to rescue (FTR) is an important measure of quality of care. The aim of this study was to assess FTR in patients with colon cancer (CC) who underwent surgical resection. We hypothesized that patient managed in urban centers had lower FTR. Methods: We performed a 1-y (2011) retrospective analysis of the National Inpatient Sample database and identified all patients with CC who underwent surgical management. Patients were stratified based on the location of treatment: urban versus rural. Outcome measure was FTR, which was defined as death after major complications. Regression analysis was performed to evaluate the independent predictors of FTR. Results: A total of 49,789 patients with CC who underwent surgery were analyzed. The mean age was 71 ± 20.2 y and 59% were males. About 21.5% patients developed in-hospital complications. The overall rates of complications, mortality, and FTR were 21.5%, 3.0%, and 33.8% respectively. Patient managed in rural centers had higher FTR compared with urban centers (39.5% versus 30.1%, P = 0.01). On regression analysis after controlling for age, gender, type of procedure, Charlson Comorbidity Index, and insurance status, management in rural center was independently associated with FTR (odds ratio: 1.9 [1.4-3.7]). On subanalysis of urban centers, management in teaching urban hospital was independently associated with higher FTR (odds ratio: 1.4 [1.2-3.8]). Conclusions: Disparities exist among centers managing patients with CC undergoing surgical intervention. Rural centers have higher FTR compared with similar cohort of patients managed in urban centers. Teaching urban hospital performed worse than nonteaching urban centers. Understanding the reason for these differences may help standardize care across centers and help improve patient outcomes.

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