‘Failure to Rescue’ from Complications following Colorectal Cancer Surgery in Aotearoa NZ

Authors List

Wells, C., Counties Manukau District Health Board, Auckland, New Zealand Varghese, C., University of Auckland, Auckland, New Zealand Boyle, L., University of Auckland, Auckland, New Zealand McGuinness, M., Northland District Health Board, Whangarei, New Zealand Keane, C., University of Auckland, Auckland, New Zealand O’Grady G., Auckland District Health Board, Auckland, New Zealand Gurney J., University of Otago, Wellington, New Zealand Koea J., Waitematā District Health Board, Auckland, New Zealand Harmston C., Northland District Health Board, Whangarei, New Zealand Bissett I., Auckland District Health Board, Auckland, New Zealand

Introduction: Wide variation in postoperative outcomes exists following colorectal cancer surgery. The Bowel Cancer Quality Improvement Report found that for patients undergoing surgery in 2013-16, unadjusted 90-day postoperative mortality ranged from 0-7.6% DHBs in Aotearoa New Zealand. ‘Failure to rescue’ (FTR) is defined as the rate of death following postoperative complications. International studies have identified FTR as a driver of hospital-level differences in postoperative mortality, however this has not been previously examined in New Zealand.

Aim
: Examine variation in FTR, mortality, and complication rates between DHBs and over time for patients undergoing colorectal cancer surgery.

Methods
: A population-based study of all patients undergoing colorectal cancer resection from 2010-2019 in Aotearoa was conducted using the New Zealand Cancer Registry and New Zealand National Minimum Dataset. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Hospitals were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year study period were examined.

Results:
Overall, 15,686 patients undergoing colorectal resection 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. From 2010 to 2019, 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 DHBs and over time remained when only analysing patients undergoing elective surgery.

Conclusions
: Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in ‘rescue’ from complications. Differences in FTR also drive DHB-level variation in mortality, highlighting the importance of ‘rescue’ as a target for surgical quality improvement.

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