Key message:
Factors associated with the risk of death within 30-days of surgery are complex. Overall, the number of post-operative deaths is falling but the risk varies across the population in relation to the characteristics of the individuals being operated upon.
30-Day Post-Operative Mortality after Colorectal Cancer Surgery in England
Background
There is increasing demand for the NHS to publish clinical outcomes, such as post-operative mortality to inform patient choice. It is important to understand, however that surgery inevitably carries a risk and that risk will vary between individuals. This study examines how 30-day post-operative mortality varies across the English colorectal cancer population.
Methods
Information on patients receiving a major resection for colorectal cancer diagnosed between 1998 and 2006 and treated in the English NHS was obtained from the National Cancer Data Repository. Post-operative mortality was defined as death within 30 days of major resection. The percentage of individuals who died within 30-days of their surgery was calculated in relation to each year of diagnosis, age group, sex, Dukes’ stage of the primary tumour at diagnosis, socioeconomic deprivation category and co-morbidity group.
Results
160,920 patients received a major resection over the study period. They were treated by 150 different surgical teams. The overall post-operative mortality rate was 6.7% but the rate improved over the study period from 6.9% in 1998 to 5.9% in 2006. (Figure 1). Post-operative mortality significantly increased with age (Figure 2), co-morbidity (Figure 3), advancing Dukes’ stage at diagnosis (Figure 4), in those residing in the most deprived areas (Figure 5) and in those patients who were treated as emergencies (Figure 6). Post-operative mortality was lower in females compared to males (Figure 7) and in patients whose tumours were in the rectosigmoid junction and rectum when compared to those who had colonic tumours (Figure 8).
Conclusions
The 30-day post-operative mortality rate is falling across England. There is, however, significant variation in post-operative mortality across the population with it being greater in the elderly, among men, the socioeconomically deprived, those with advanced stage disease at diagnosis or with additional co-morbidities and among those operated upon as emergencies.
Figure 1: 30-day post-operative mortality in relation to year of diagnosis
Figure 2: 30-day post-operative mortality in relation to patient age
Figure 3: 30-day post-operative mortality in relation to co-morbidity
Figure 4: 30-day post-operative mortality In relation to Dukes’ stage at diagnosis
Figure 5: 30-day post-operative mortality in relation to socioeconomic status
Figure 6: 30-day post-operative mortality in relation to operation type
Figure 7: 30-day post-operative mortality in relation to sex
Figure 8: 30-day post-operative mortality in relation to tumour site
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