Clinical Epidemiology (Jul 2023)

Uneven Between-Hospital Distribution of Patient-Related Risk Factors for Adverse Outcomes of Colorectal Cancer Treatment: A Population-Based Register Study

  • Rattenborg S,
  • Möller S,
  • Frostberg E,
  • Rahr HB

Journal volume & issue
Vol. Volume 15
pp. 867 – 880

Abstract

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Søren Rattenborg,1,2 Sören Möller,3,4 Erik Frostberg,1,2 Hans B Rahr1,2,5 1Department of Surgery, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark; 2Colorectal Cancer Center South, Vejle, Denmark; 3Open Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 5Institute of Regional Health Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Søren Rattenborg, Department of Surgery, Vejle Hospital, Beriderbakken 4, Vejle, 7100, Denmark, Tel +45-79405000, Email [email protected]: The purpose of this study was to elucidate between-hospital variation in the prevalence at the time of diagnosis of patient-related risk factors for adverse outcomes of colorectal cancer (CRC) treatment.Patients and Methods: A register-based national cohort of 44,471 patients diagnosed with CRC and registered in the Danish Colorectal Cancer Group database in 2009– 2018 was included in the study. Patient-related risk factors present at diagnosis were collected from national Danish registers within the areas of demography, lifestyle factors, comorbidity, participation in screening, disease-related factors and socioeconomic factors. Prediction models of short-term postoperative outcomes and mortality were modelled to examine the potential aggregated impact of patient-related risk factors on outcomes, and variations between hospitals were examined.Results: The most conspicuous variations found were for old age (75+ years), ranging from 31% (95% confidence interval (95% CI): 29– 33%) to 46% (95% CI: 43– 48%), Union for International Cancer Control Stage I ranging from 12% (95% CI: 10– 14%) to 21% (95% CI: 19– 22%), Stage IV ranging from 23% (95% CI: 21– 25%) to 35% (95% CI: 34– 37%) and American Society of Anesthesiologists score ≥III ranging from 18% (95% CI: 16– 19%) to 40% (95% CI: 37– 43%). Clinically significant variations were found in predicted probability of 30-day surgical complications which varied from 17% (95% CI: 16– 17%) to 23% (95% CI: 22– 23%) and 90-day postoperative mortality which varied between 3.2% (95% CI: 3– 3.4%) and 5.5% (95% CI: 4.9– 6%).Conclusion: Marked variation in the prevalence of patient-related risk factors for adverse outcomes of colorectal cancer treatment exists between hospitals in Denmark. It seems reasonable to take these differences into account when comparing outcomes between hospitals.Keywords: colorectal cancer, morbidity, mortality, risk factors, surgery

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