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

Abstract

Purpose

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

Acknowledgments

The authors would like to thank Region of Southern Denmark and Lillebaelt Hospital for financial support for this project. In addition, the authors would like to thank DCCG for assistance and permission to extract the population and colorectal-specific data essential for this study.

Disclosure

The authors report no conflicts of interest in this work.