Impact of hospital geographic remoteness on short-term outcomes after colorectal cancer resection using state-wide administrative data

Impact of surgeon and hospital factors on length of stay after colorectal surgery systematic review

Background

Although length of stay (LOS) after colorectal surgery (CRS) is associated with worse patient and system level outcomes, the impact of surgeon and hospital-level factors on LOS after CRS has not been well investigated. The aim of this study was to synthesize the evidence for the impact of surgeon and hospital-level factors on LOS after CRS.

Methods

A comprehensive database search was conducted using terms related to LOS and CRS. Studies were included if they reported the effect of surgeon or hospital factors on LOS after elective CRS. The evidence for the effect of each surgeon and hospital factor on LOS was synthesized using vote counting by direction of effect, taking risk of bias into consideration.

Results

A total of 13 946 unique titles and abstracts were screened, and 69 studies met the inclusion criteria. All studies were retrospective and assessed a total of eight factors. Surgeon factors such as increasing surgeon volume, colorectal surgical specialty, and progression along a learning curve were significantly associated with decreased LOS (effect seen in 87.5 per cent, 100 per cent, and 93.3 per cent of studies respectively). In contrast, hospital factors such as hospital volume and teaching hospital status were not significantly associated with LOS.

Conclusion

Provider-related factors were found to be significantly associated with LOS after elective CRS. In particular, surgeon-related factors related to experience specifically impacted LOS, whereas hospital-related factors did not. Understanding the mechanisms underlying these relationships may allow for tailoring of interventions to reduce LOS.

Postoperative complications, length of stay, and mortality following colectomies in rural hospitals: a systematic review and meta-analysis

INTRODUCTION

Studies regarding patients who have underwent colectomy reported contradictory post-surgical complications based on their living areas. Due to the conflicting data surrounding whether rural or urban hospitals have lower postoperative complication rates, we have performed a systematic review and meta-analysis with the aim of understanding and assessing the evidence that has already been found.

METHODS

The online databases PubMed, MEDLINE, EMBASE, SCOPUS and CINAHL were searched for our literature review. We included papers with data on the postoperative complication rates for patients who had undergone colectomies. The patients were stratified based on the location status of the hospital, i.e., rural or urban. Data analysis was performed in Cochrane's Review Manager 5.41 software.

RESULTS

A total of 921 studies were identified in initial search; the inclusion and exclusion criteria refined the search results to 11 studies for review. The primary outcomes analysed were mortality rate, length of stay and total complication rate. This review found that rural hospitals had either equal or lower inpatient postoperative mortality rates in comparison to urban hospitals for patients who had undergone colectomies. However, rural hospitals had a longer length of stay (mean length of stay in rural hospitals was 6.7 days and in urban hospitals was 4.9 days). Important to note that the Australian hospitals had a mean length of stay of 13.5 days, which was almost double that of rural hospitals in America. The unadjusted rate of total complication was 26.51% in rural hospitals.

CONCLUSIONS

Rural hospitals overall have equivalent postoperative complication rates to urban hospitals and can provide sufficient postoperative patient care.

Colorectal cancer databases and registries in Australia: what data is available?

BACKGROUND

There are multiple data sources relating to colorectal cancer (CRC) nationwide. Prospective clinical cancer databases, population-based registries and linked administrative data are powerful tools in clinical outcomes research and provide real-world perspective on cancer treatments. This study aims to review the different Australian data sources for CRC from the perspective of conducting comparative research studies using a PICO (patient, intervention, comparison, outcome) framework.

METHODS

Data dictionaries from the different data sources were evaluated for the types of exposure and outcome variables contained to highlight their differing research utility.

RESULTS

State or territory-based cancer registries contain limited histology, cancer staging and treatment detail. They enable investigation of population-level patterns in overall survival (OS) of cancer patients with different demographics. Prospective clinical cancer databases contain more detail, especially surgical. Their strength is in auditing short-term surgical outcomes. They vary in the amount of data collected for other cancer treatments and completion of follow up data. Linked administrative databases have broad population coverage but less surgical detail. They provide population-level data on treatment patterns, short-term outcome measures and OS, as well as long-term surgical outcomes such as identifying patients who did not undergo stoma reversal. These databases cannot assess disease-free survival.

CONCLUSION

Of the various CRC data sources within Australia, linked administrative databases have the potential to provide the widest population coverage combined with the broadest range of exposures and outcomes, and arguably the most research utility.