Abstract
Background and objectivesIt 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.MethodsAll 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.ResultsPatients 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.ConclusionOn 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.
Highlights
Colon cancer is one of the most common malignancies in the world
Patients treated in teaching and academic hospitals showed higher adjusted serious complication rates, compared to patients treated in general hospitals
Patients treated in teaching hospitals had lower adjusted failure to rescue (FTR) rates than patients treated in general hospitals
Summary
Colon cancer is one of the most common malignancies in the world. It is the third leading cause of diagnosed cancer in males and the second in females. Academic hospitals (n = 8) are all associated with Dutch universities and are responsible for education and surgical training These hospitals function as tertiary referral centers for a selected group of patients with colon cancer. The general hospitals are usually lower volume hospitals considered to provide accessible care with the possibility to refer to teaching or academic hospitals when necessary [3, 4]. These different ‘hospital teaching types’ differ in organization of the perioperative processes, personal concerned with the ward and short or long lines of communication, all factors that are described to influence outcomes in colon cancer surgery. 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
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