Failure to Rescue following Colorectal Cancer Resection Variation and Improvements in a National Study of Postoperative Mortality

Objective:To examine variation in failure to rescue (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. Background:Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences in mortality both between hospitals and over time are driven by variation in FTR. Methods:A national population-based study of patients undergoing colorectal cancer resection from 2010 to 2019 in Aotearoa New Zealand was conducted. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Twenty District Health Boards (DHBs) were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year period were examined. Results:Overall, 15,686 patients undergoing resection for colorectal adenocarcinoma were included. Increased postoperative mortality at high-mortality centers (OR 2.4, 95% CI 1.8-3.3) was driven by higher rates of FTR (OR 2.0, 95% CI 1.5-2.8), and postoperative complications (OR 1.4, 95% CI 1.3-1.6). These trends were consistent across operative and nonoperative complications. Over the 2010 to 2019 period, postoperative mortality halved (OR 0.5, 95% CI 0.4-0.6), associated with a greater improvement in FTR (OR 0.5, 95% CI 0.4-0.7) than complications (OR 0.8, 95% CI 0.8-0.9). Differences between centers and over time remained when only analyzing patients undergoing elective surgery. Conclusion:Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in rescue from complications. Differences in FTR also drive hospital-level variation in mortality, highlighting the central importance of rescue as a target for surgical quality improvement.

Automated summary

The objective of this study was to examine whether variation in failure to rescue (FTR) contributes to differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. The study found that high-mortality centres were characterized by higher rates of FTR and postoperative complications, and the improvement in FTR over the past decade was the main factor driving the decrease in mortality.