Operative mortality after colorectal resection in the Netherlands

BACKGROUND: The aim of this study was to quantify factors related to operative mortality after colorectal resection in the Netherlands. METHODS: Multilevel logistic regression modelling was used. Institutional effects were calculated with and without adjustment for specific patient (age, sex, urgency of operation) and hospital (number of procedures, type of hospital) characteristics. All adult Dutch patients who underwent primary colorectal resection between 1994 and 1999 were included, except those who had (sub)total colectomy or local rectal resection. RESULTS: A total of 67 594 patients underwent colorectal resection. The in-hospital mortality rate was 7.0 per cent (elective 3.9 per cent, acute 14.3 per cent). Acute operation (odds ratio 3.89) and age (odds ratios 2.63, 5.23 and 10.13 for patients aged 50-69, 70-79 and 80 or more years respectively compared with those aged less than 50 years) had the strongest effects, followed by male sex (odds ratio 1.48) and type of hospital. There was no difference in operative mortality rate between low-, medium- and high-volume hospitals. CONCLUSION: In the Netherlands, advanced age and acute operation are by far the most important factors related to operative mortality after colorectal resection. Male sex and type of hospital have only a modest effect, and there is no discernible effect of hospital volume.