Colorectal Cancer Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, St James's Institute of Oncology, St James's Hospital Leeds, Leeds, UK.
Gut. 2011 Jun;60(6):806-13. doi: 10.1136/gut.2010.232181. Epub 2011 Apr 12.
To assess the variation in risk-adjusted 30-day postoperative mortality for patients with colorectal cancer between hospital trusts within the English NHS.
Retrospective cross-sectional population-based study of data extracted from the National Cancer Data Repository.
All providers of major colorectal cancer surgery within the English NHS.
All 160,920 individuals who underwent major resection for colorectal cancer diagnosed between 1998 and 2006 in the English NHS. Main outcome measures National patterns of 30-day postoperative mortality were examined and logistic binary regression was used to study factors associated with death within 30 days of surgery. Funnel plots were used to show variation between trusts in risk-adjusted mortality.
Overall 30-day mortality was 6.7% but decreased over time from 6.8% in 1998 to 5.8% in 2006. The largest reduction in mortality was seen in 2005 and 2006. Postoperative mortality increased with age (15.0% (95% CI 14.1% to 15.9%) for those aged >80 years), comorbidity (24.2% (95% CI 22.0% to 26.5%) for those with a Charlson comorbidity score ≥ 3), stage of disease (9.9% (95% CI 9.3% to 10.6%) for patients with Dukes' D disease), socioeconomic deprivation (7.8% (95% CI 7.2% to 8.4%) for residents of the most deprived quintile) and operative urgency (14.9% (95% CI 14.2% to 15.7%) for patients undergoing emergency resection). Risk-adjusted control charts showed that one trust had consistently significantly better outcomes and three had significantly worse outcomes than the population mean.
Significant variation in 30-day postoperative mortality following major colorectal cancer surgery existed between NHS hospitals in England throughout the period 1998-2006. Understanding the underlying causes of this variation between surgical providers will make it possible to identify and spread best practice, improve outcomes and, ultimately, reduce 30-day postoperative mortality following colorectal cancer surgery.
评估英国国家医疗服务体系（NHS）内不同医院信托基金之间接受结直肠癌治疗的患者术后 30 天风险调整死亡率的差异。
对国家癌症数据库中提取的数据进行回顾性的基于人群的横断面研究。
英国 NHS 内所有主要结直肠癌手术提供者。
1998 年至 2006 年间在英国 NHS 接受主要结直肠癌切除术的 160920 名患者。主要观察指标：检查术后 30 天内死亡率的国家模式，并使用逻辑二元回归分析与术后 30 天内死亡相关的因素。使用漏斗图显示信托基金之间风险调整死亡率的差异。
总体术后 30 天死亡率为 6.7%，但随着时间的推移逐渐下降，从 1998 年的 6.8%下降到 2006 年的 5.8%。死亡率最大降幅出现在 2005 年和 2006 年。术后死亡率随年龄增长而增加（80 岁以上患者为 15.0%（95%可信区间 14.1%至 15.9%）），合并症（Charlson 合并症评分≥3 分的患者为 24.2%（95%可信区间 22.0%至 26.5%）），疾病分期（Dukes'D 期患者为 9.9%（95%可信区间 9.3%至 10.6%）），社会经济剥夺（最贫困五分位数的居民为 7.8%（95%可信区间 7.2%至 8.4%））和手术紧急程度（急诊手术患者为 14.9%（95%可信区间 14.2%至 15.7%））。风险调整控制图显示，1 家信托基金的结果始终明显优于人群平均水平，而 3 家信托基金的结果明显差于人群平均水平。
1998 年至 2006 年间，英格兰 NHS 内不同医院之间接受结直肠癌主要手术后 30 天内的术后死亡率存在显著差异。了解手术提供者之间这种差异的潜在原因将有可能识别和推广最佳实践，改善结果，并最终降低结直肠癌手术后 30 天内的死亡率。
