TY - JOUR
T1 - Hospital Teaching Status and Patients’ Outcomes After Colon Cancer Surgery
AU - van Groningen, Julia T.
AU - Eddes, Eric H.
AU - Fabry, Hans F.J.
AU - van Tilburg, Marc W.A.
AU - van Nieuwenhoven, Ernst J.
AU - Snel, Yvonne
AU - Marang-van de Mheen, Perla J.
AU - de Noo, Mirre E.
AU - On behalf of the Dutch Surgical Colorectal Cancer Audit Group and the Co-operating General Hospitals
PY - 2018
Y1 - 2018
N2 - Background and objectives: It is increasingly accepted that quality of colon cancer surgery might be secured by combining volume standards with audit implementation. However, debate remains about other structural factors also influencing this quality, such as hospital teaching status. This study evaluates short-term outcomes after colon cancer surgery of patients treated in general, teaching or academic hospitals. Methods: All patients (n = 23,593) registered in the Dutch Colorectal Audit undergoing colon cancer surgery between 2011 and 2014 were included. Patients were divided into groups based on teaching status of their hospital. Main outcome measures were serious complications, failure to rescue (FTR) and 30-day or in-hospital mortality. Multivariate logistic regression models on these outcome measures and with hospital teaching status as primary determinant were used, adjusted for case-mix, year of surgery and hospital volume. Results: Patients treated in teaching and academic hospitals showed higher adjusted serious complication rates, compared to patients treated in general hospitals (odds ratio 1.25 95% CI [1.11–1.39] and OR 1.23 [1.05–1.46]). However, patients treated in teaching hospitals had lower adjusted FTR rates than patients treated in general hospitals (OR 0.63 [0.44–0.89]). However, for all outcomes there was considerable between-hospitals variation within each type of teaching status. Conclusion: On average, patients treated in general hospitals had lower serious complication rates, but patients treated in teaching hospitals had more favorable FTR rates. Given the hospital variation within each hospital teaching type, it is possible to deliver excellent care regardless of the hospital teaching type.
AB - Background and objectives: It is increasingly accepted that quality of colon cancer surgery might be secured by combining volume standards with audit implementation. However, debate remains about other structural factors also influencing this quality, such as hospital teaching status. This study evaluates short-term outcomes after colon cancer surgery of patients treated in general, teaching or academic hospitals. Methods: All patients (n = 23,593) registered in the Dutch Colorectal Audit undergoing colon cancer surgery between 2011 and 2014 were included. Patients were divided into groups based on teaching status of their hospital. Main outcome measures were serious complications, failure to rescue (FTR) and 30-day or in-hospital mortality. Multivariate logistic regression models on these outcome measures and with hospital teaching status as primary determinant were used, adjusted for case-mix, year of surgery and hospital volume. Results: Patients treated in teaching and academic hospitals showed higher adjusted serious complication rates, compared to patients treated in general hospitals (odds ratio 1.25 95% CI [1.11–1.39] and OR 1.23 [1.05–1.46]). However, patients treated in teaching hospitals had lower adjusted FTR rates than patients treated in general hospitals (OR 0.63 [0.44–0.89]). However, for all outcomes there was considerable between-hospitals variation within each type of teaching status. Conclusion: On average, patients treated in general hospitals had lower serious complication rates, but patients treated in teaching hospitals had more favorable FTR rates. Given the hospital variation within each hospital teaching type, it is possible to deliver excellent care regardless of the hospital teaching type.
UR - http://www.scopus.com/inward/record.url?scp=85044355090&partnerID=8YFLogxK
U2 - 10.1007/s00268-018-4580-3
DO - 10.1007/s00268-018-4580-3
M3 - Article
C2 - 29572565
AN - SCOPUS:85044355090
SN - 0364-2313
VL - 42
SP - 3372
EP - 3380
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 10
ER -