Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery

Mario Schootman, Min Lian, Sandi L. Pruitt, Anjali D. Deshpande, Samantha Hendren, Matthew Mutch, Donna B. Jeffe, Nicholas Davidson

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients. Data Sources/Study Setting Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals. Study Design An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality. Data Collection/Extraction Methods We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data. Principal Findings Of 47,459 CRC patients, 6.6 percent died within 30 days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30 days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent). Conclusions Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.

Original languageEnglish (US)
Pages (from-to)1145-1164
Number of pages20
JournalHealth Services Research
Volume49
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Colorectal Surgery
Colorectal Neoplasms
Censuses
Mortality
Medicare
Epidemiology
Neoplasms
Information Storage and Retrieval
Poverty
Hospital Mortality
Ambulatory Surgical Procedures
Observational Studies
Emergencies
Logistic Models
Economics
Therapeutics
Population

Keywords

  • Colorectal cancer
  • multilevel
  • neighborhood
  • poverty

ASJC Scopus subject areas

  • Health Policy

Cite this

Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery. / Schootman, Mario; Lian, Min; Pruitt, Sandi L.; Deshpande, Anjali D.; Hendren, Samantha; Mutch, Matthew; Jeffe, Donna B.; Davidson, Nicholas.

In: Health Services Research, Vol. 49, No. 4, 2014, p. 1145-1164.

Research output: Contribution to journalArticle

Schootman, M, Lian, M, Pruitt, SL, Deshpande, AD, Hendren, S, Mutch, M, Jeffe, DB & Davidson, N 2014, 'Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery', Health Services Research, vol. 49, no. 4, pp. 1145-1164. https://doi.org/10.1111/1475-6773.12171a
Schootman, Mario ; Lian, Min ; Pruitt, Sandi L. ; Deshpande, Anjali D. ; Hendren, Samantha ; Mutch, Matthew ; Jeffe, Donna B. ; Davidson, Nicholas. / Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery. In: Health Services Research. 2014 ; Vol. 49, No. 4. pp. 1145-1164.
@article{3a040b4cbf3f4e88abe5a46676caf3ce,
title = "Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery",
abstract = "Objective To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients. Data Sources/Study Setting Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals. Study Design An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality. Data Collection/Extraction Methods We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data. Principal Findings Of 47,459 CRC patients, 6.6 percent died within 30 days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30 days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent). Conclusions Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.",
keywords = "Colorectal cancer, multilevel, neighborhood, poverty",
author = "Mario Schootman and Min Lian and Pruitt, {Sandi L.} and Deshpande, {Anjali D.} and Samantha Hendren and Matthew Mutch and Jeffe, {Donna B.} and Nicholas Davidson",
year = "2014",
doi = "10.1111/1475-6773.12171a",
language = "English (US)",
volume = "49",
pages = "1145--1164",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery

AU - Schootman, Mario

AU - Lian, Min

AU - Pruitt, Sandi L.

AU - Deshpande, Anjali D.

AU - Hendren, Samantha

AU - Mutch, Matthew

AU - Jeffe, Donna B.

AU - Davidson, Nicholas

PY - 2014

Y1 - 2014

N2 - Objective To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients. Data Sources/Study Setting Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals. Study Design An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality. Data Collection/Extraction Methods We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data. Principal Findings Of 47,459 CRC patients, 6.6 percent died within 30 days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30 days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent). Conclusions Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.

AB - Objective To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients. Data Sources/Study Setting Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals. Study Design An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality. Data Collection/Extraction Methods We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data. Principal Findings Of 47,459 CRC patients, 6.6 percent died within 30 days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30 days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent). Conclusions Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.

KW - Colorectal cancer

KW - multilevel

KW - neighborhood

KW - poverty

UR - http://www.scopus.com/inward/record.url?scp=84905013684&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905013684&partnerID=8YFLogxK

U2 - 10.1111/1475-6773.12171a

DO - 10.1111/1475-6773.12171a

M3 - Article

C2 - 24673560

AN - SCOPUS:84905013684

VL - 49

SP - 1145

EP - 1164

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 4

ER -