Key result
High mortality hospitals are linked to ~223% higher odds of case-fatality after complications.
Why the study?
Wide variation in hospital mortality rates after elective cancer surgery exists, but the clinical mechanisms underlying these differences are uncertain.
Does treatment at high mortality hospitals compared to low mortality hospitals affect complication incidence or case-fatality rates in patients undergoing cancer surgery?
Population
5,632 patients undergoing cancer surgery at 49 hospitals from the 2006–2007 National Cancer Data Base
Comparison
High mortality hospitals (9.1%) vs low mortality hospitals (2.1%)
Design
National cohort study with detailed medical record review and hierarchical logistic regression
Follow-up
Perioperative period
Authors
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Failure to rescue drives mortality differences after cancer surgery; hypothesis-generating for rescue-focused interventions in observational cohorts.
Cohort (n=5,632)
Yes
Does treatment at high mortality hospitals compared to low mortality hospitals affect complication incidence or case-fatality rates in patients undergoing cancer surgery?
Odds Ratio: 3.23 (95% CI 1.56–6.69)
Absolute Event Rate: 25.9% vs 13.6%
Differences in hospital mortality rates after cancer surgery are driven primarily by failure to rescue (case-fatality after complications) rather than the incidence of complications.
Wong et al. (2014) conducted a cohort in Cancer surgery (n=5,632). High mortality hospitals vs. Low mortality hospitals was evaluated on Case-fatality after complications (OR 3.23, 95% CI 1.56-6.69). High mortality hospitals had a significantly higher case-fatality rate after complications compared to low mortality hospitals (25.9% vs 13.6%; OR 3.23, 95% CI 1.56-6.69).
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