Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands

Kolfschoten, N.E.; Mheen, Perla J Marang-van de; Gooiker, G.A.; Eddes, E.H.; Kievit, J.; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.

doi:10.1016/j.ejso.2011.08.137

Cited by 61 publications

(67 citation statements)

References 14 publications

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“…17,18 Clinical data was retrieved from the detailed DSCA dataset, therefore enabling accurate risk-adjustment. 13 Moreover, since the DSCA is a population-based registry, the data was not hampered by overrepresentation of a specific group of patients (Table 1). In contrast, two recent multi-center studies from the United States analyzing costs of complications retrieved their data from Veterans Affairs hospitals.…”

Section: Discussionmentioning

confidence: 99%

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals

Govaert

Fiocco

Dijk³

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Section: Discussionmentioning

confidence: 99%

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals

Govaert

Fiocco

Dijk³

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…For colon cancer, the location of the tumor within the colon was added to the casemix and for rectal cancer the casemix was expanded with tumor distance from anal verge, cT-classification, pre-operative radiotherapy (no radiotherapy, short course radiotherapy or chemoradiotherapy), and surgical procedure (Low Anterior Resection, Abdominal Perineal Resection or different). Further details on casemix correction are described in previous studies [23]. Because we were interested in conversion and the outcomes of conversion over the years, we also included the risk factor previous abdominal surgery and the year of operation to the standard casemix.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

et al. 2018

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Conversion of laparoscopic colorectal cancer resection has been associated with worse outcome, but this might have been related to a learning curve effect. This study aimed to evaluate incidence, predictive factors and outcomes of laparoscopic conversion after the implementation phase of laparoscopic surgery at a population level. Patients undergoing elective resection of non-locally advanced, non-metastatic colorectal cancer between 2011 and 2015 were included. Data were extracted from the Dutch Surgical Colorectal Audit. Patients were grouped as laparoscopic completed (LR), laparoscopic converted (CONV) with further specification of timing (within or after 30 min) as registered in the DSCA, and open resection (OR). Uni- and multi-variate analyses were used to determine predictors of conversion and outcome (complicated course and mortality), with evaluation of trends over time. A total of 23,044 patients with colon cancer and 11,324 with rectal cancer were included. Between 2011 and 2015, use of laparoscopy increased from 55 to 84% in colon cancer, and from 49 to 89% in rectal cancer. Conversion rates decreased from 11.8 to 8.6% and from 13 to 8.0%, respectively. Laparoscopic hospital volume was independently associated with conversion rate. Only for colon cancer, the rate of complicated course was significantly higher after CONV compared to OR (adjusted odds ratio 1.486; 95% CI 1.298–1.702), and significantly higher after late (> 30 min) compared to early conversion (adjusted odds ratio 1.341; 1.046–1.719). There was no impact of CONV on mortality in both colon and rectal cancer. The use of laparoscopic colorectal cancer surgery increased to more than 80% at a national level, accompanied by a decrease in conversion which is significantly related to the laparoscopic hospital volume. Conversion was only associated with complicated course in colon cancer, especially when the reason for conversion consisted of an intra-operative complication, without affecting mortality.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6042-2) contains supplementary material, which is available to authorized users.

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“…The estimated completeness of the DSCA in 2010, if compared to the Netherlands Cancer Registry, was 93% (www.dsca.nl) [6,7]. Details of this dataset are described elsewhere [8].…”

Section: Patientsmentioning

confidence: 99%

Nonelective Colon Cancer Resections in Elderly Patients: Results from the Dutch Surgical Colorectal Audit

Kolfschoten¹,

Wouters

Gooiker³

et al. 2012

Dig Surg

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Aims: The aim of the study was to assess which factors contribute to postoperative mortality, especially in elderly patients who undergo emergency colon cancer resections, using a nationwide population-based database. Methods: 6,161 patients (1,172 nonelective) who underwent a colon cancer resection in 2010 in the Netherlands were included. Risk factors for postoperative mortality were investigated using a multivariate logistic regression model for different age groups, elective and nonelective patients separately. Results: For both elective and nonelective patients, mortality risk increased with increasing age. For nonelective elderly patients (80+ years), each additional risk factor increased the mortality risk. For a nonelective patient of 80+ years with an American Society of Anesthesiologists score of III+ and a left hemicolectomy or extended resection, postoperative mortality rate was 41% compared with 7% in patients without additional risk factors. Conclusions: For elderly patients with two or more additional risk factors, a nonelective resection should be considered a high-risk procedure with a mortality risk of up to 41%. The results of this study could be used to adequately inform patient and family and should have consequences for composing an operative team.

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Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands

Cited by 61 publications

References 14 publications

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

Nonelective Colon Cancer Resections in Elderly Patients: Results from the Dutch Surgical Colorectal Audit

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