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26-04-2011 | Gastroenterology | Article

1-month survival after colorectal cancer surgery varies markedly across England


Free abstract

MedWire News: Significant variation in 30-day survival post-colorectal cancer surgery exists among National Health Service (NHS) hospital trusts in England, according to findings from a UK study conducted throughout 1998-2006.

The results arise from the analysis of 160,920 colorectal cancer patients who underwent tumor resection in an NHS hospital during the study period. Of these, 6.7% (n=10,704) died within 30 days of surgery.

A trend for decreasing 30-day mortality rates over time was observed by Eva Morris (St James' Hospital, Leeds) and team, with a rate of 6.8% occurring in 1998 and 5.8% in 2006.

The analysis revealed that several factors influenced the risk for postoperative mortality. For example, each year increase in patient age increased 30-day mortality risk by 8%, and having surgery as an emergency increased this risk 2.67 fold.

After adjustment for these factors, Morris and colleagues noted that of all the hospital trusts included in the study - all English trusts that perform colorectal cancer resections - one had significantly lower mortality rates than the group's mean rate, and three had significantly higher rates (below and above the 99.8% upper control limit, respectively).

"These [latter] hospitals were all district general hospitals and two of those had Foundation status," remark the authors.

They also report, in the journal Gut, that the 6.7% overall mortality rate observed during the study period is much higher than that reported in other countries.

"Thirty-day postoperative mortality from population-based studies in Scandinavia, Canada, and the USA ranged from 2.7% to 5.7%," explain Morris and team.

"This suggests that either the NHS may have fundamentally worse postoperative outcomes than some other comparable health services or the operative risk of patients differs between countries," conclude the authors.

They suggest that it is important to identify the reason for intra- and inter-country variations in postoperative mortality rates, in order to minimize these differences.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lauretta Ihonor

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