Surgery at academic hospitals was associated with a 7% lower adjusted risk of 5-year all-cause mortality compared to non-academic hospitals in colorectal cancer patients (HR 1.07, 95% CI 1.04-1.11).
Cohort (n=49,032)
Yes
Does hospital academic status affect survival in patients undergoing colorectal cancer surgery?
Hospital academic status is associated with slightly improved 5-year mortality following colorectal cancer surgery, though the benefit appears limited to rectal cancer.
Effect estimate: HR 1.07 for non-academic vs academic hospitals (95% CI 95% CI 1.04-1.11)
Absolute Event Rate: 40.1% vs 45.6%
Abstract There is a lack of evidence regarding hospital academic status and survival following colorectal cancer surgery and there is a paucity of data from European countries. The aim of this study was to investigate this association between hospital academic status and mortality after colon and rectal cancer surgery. All 49 032 patients who underwent resection for colorectal cancer in years 1987–2016 in Finland were included, with complete follow-up until December 31, 2019. Primary outcome was all-cause 5-year mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) in academic and non-academic hospitals for colorectal surgery, adjusted for calendar period, age, sex, comorbidity, stage, tumor location and oncological therapy. Additionally, colon and rectal cancer surgery were assessed separately. Total colectomies were included in the study, and the cancer location was based on the first location information that was reported by the cancer registry or in the ICD code if not reported in the cancer registry. The manuscript was written according to Equator network guidelines. Compared to academic hospitals, the patients operated in non-academic hospitals had a slightly increased 5-year all-cause mortality (adjusted HR 1.07, 95% CI 1.04–1.11) and also the 30-day and 90-day mortality was increased in patients operated in non-academic hospitals. Sensitivity analysis including only patients operated with confirmed curative intent suggested no differences between academic and non-academic hospitals in colorectal cancer for 5-year all-cause mortality or in 5-year cancer specific mortality, respectively. In analysis including hospital volume as an explanatory covariate, the increase in 5-year mortality in non-academic hospitals compared to academic hospitals was stronger than in main analysis. A pre-planned subgroup-analysis stratified by cancer type (colon, or rectal) suggested a slightly decreased 5-year all-cause mortality in academic institutions for rectal but not for colon cancer surgery. Hospital academic status is associated with slightly improved 5-year mortality in colorectal cancer surgery, but benefits of centralization to academic hospitals may be limited to rectal cancer surgery.
Sarjanoja et al. (Tue,) conducted a cohort in Patients with incident colorectal cancer undergoing resectional surgery within one year of diagnosis in Finland from 1987-2016 (n=49,032). Surgery at academic hospital vs. Surgery at non-academic hospital was evaluated on 5-year all-cause mortality (HR 1.07 for non-academic vs academic hospitals, 95% CI 95% CI 1.04-1.11). Surgery at academic hospitals was associated with a 7% lower adjusted risk of 5-year all-cause mortality compared to non-academic hospitals in colorectal cancer patients (HR 1.07, 95% CI 1.04-1.11).