Bowel Surgery Death Rate Variation 'Significant'

The 30 day survival rate after bowel/rectal cancer surgery varies considerably among hospital trusts in England, even after taking account of factors likely to influence the risk of death, shows research published online in Gut.



Bowel cancer is the third most common cancer in the UK, with more than 35,000 new cases diagnosed every year. And comparisons with comparable data from other countries show that the chances of surviving the disease in the UK are relatively poor.



The authors base their findings on an analysis of the 30 day survival rates of just under 161,000 patients who underwent major bowel cancer surgery at 150 different hospitals across England between 1998 and 2006.



The figures were adjusted for risk to take account of the complexity of the case mix, workload, and any underlying medical problems that would have affected the chances of survival after major surgery.



Unsurprisingly, the likelihood of dying after major surgery for bowel cancer was higher among older patients, especially those aged over 80; those with other underlying conditions, and those whose disease was more advanced.



Risk of death was also greater among those living in areas of deprivation and those who needed emergency surgery. 

Women were significantly less likely to die after surgery than men, as were those who underwent surgery for rectal rather than bowel cancer.



Overall, the proportion of people who died within 30 days of major surgery for bowel cancer during the entire period was just under 7% (6.7%; 10,704 deaths) across all hospital trusts in England undertaking the procedure.



The percentage fell over time, dropping from 6.8% in 1998 to 5.8% in 2006. But while one trust had significantly better outcomes, three trusts had significantly worse outcomes over time, two of which were foundation trusts.



“The postoperative mortality of 6.7% seen in this study is notably higher than that previously reported for the UK,” commented the authors, who add that the figures are “significantly higher than that reported from other countries.”

They added: 

“This suggests that either the NHS may have fundamentally worse postoperative outcomes than some other comparable health services or that the operative risk of patients differs between countries.”

“Understanding and minimising these differences could significantly reduce the number of premature deaths caused by the disease across the country,” they concluded, adding that the decision to publicise death rates after cardiothoracic surgery has demonstrably improved survival rates among these patients.

(BMcN/GK)