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Variation in Outcomes Between Elective and Non-Elective Colorectal Surgery: a Population-Based Cohort Study
Ben E. Byrne*1, Ravikrishna Mamidanna2, Charles a. Vincent1, Omar Faiz2,3
1Centre for Patient Safety and Service Quality, Imperial College London, London, United Kingdom; 2Department of Surgery and Cancer, Imperial College London, London, United Kingdom; 3Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital, Harrow, United Kingdom
Background: Elective and non-elective colorectal surgical outcomes are often studied together. Differences are examined to aid outcome selection for reporting and direct quality improvement.
Methods: Adults undergoing major colorectal resections during 2001-2007 in English National Health Service (NHS) Trusts were included. Patient and procedure characteristics, and 90-day mortality were examined. Outliers for adjusted institutional mortality were identified on funnel plots for elective and non-elective cohorts. Observed-to-expected mortality ratios were correlated.
Results: 171 330 patients treated in 151 NHS Trusts were included. 90-day mortality was 6% (6 336 of 112 222 patients) and 22% (13 111 of 59 108 patients) after elective and non-elective surgery, respectively. Cohorts were significantly different for all characteristics. No unit with high outlying mortality for elective surgery was a high outlier for non-elective mortality, and vice-versa. Observed-to-expected mortality correlated moderately (ρ=0.501, p<0.001).
Conclusions: Patient characteristics for elective and non-elective surgery were different. High unit-level mortality was not consistent across cohorts. Both cohorts` outcomes should be reported publicly. High absolute non-elective mortality highlights its importance for further study and quality improvement.
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