Date Published: 11 April 2011

Variations in outcomes of bowel cancer surgery in England

Variations in the outcomes of bowel cancer surgery in England are cause for concern according to recent research published in the journal Gut.

Researchers at Leeds University (West Yorkshire, England) reviewed the cases of patients who had major surgery to remove bowel cancer between 1998 and 2006, paying particular attention to how many of those patients had survived 30 days after their operation. They found that some NHS hospitals in England had many more patient deaths immediately after surgery than others.

Overall, 6.7% of patients (10,704) died within 30 days of their surgery - a proportion which is higher than other countries such as Scandinavia, Canada and the USA, where comparable figures range from 2.7% (for rectal cancer only) to 5.7%. The researchers also found a reduction over time in the percentage of deaths occurring. In 1998, almost 6.8% of patients died within 30 days of their bowel cancer surgery, but this had declined to almost 5.8% by 2006.

Deaths within 30 days following surgery in England were higher in certain groups including men, the elderly, people who had advanced cancer, presented as emergencies, and those who also had other diseases. Even after taking such other factors into account, there was also variation between NHS hospital trusts with three hospitals over the study period having significantly higher percentages of deaths within 30 days following surgery and one having far fewer deaths.

This information and methodology has been used to examine the latest data from the five poorest performing trusts, as well as the three best trusts in 2007-08. Preliminary data shows that all of the five trusts performed better from 2007-08.

Professor Paul Finan is an author of the study and Professor of Colorectal Surgery at the University of Leeds. He said:

" It's very encouraging to see that overall the 30-day postoperative mortality rate is decreasing across the country. But, having adjusted for those factors that can affect post-operative mortality, it is a concern that there is significant variation between hospitals.
_ Understanding why this has occurred is a complex matter and is now a priority for the National Cancer Intelligence Network and the wider cancer community. It's vital to learn from the Trusts with very low post-operative mortality so that we can identify and spread best practice across the NHS and so help to reduce post-operative mortality further."

Dr Eva Morris, another author of the study and research fellow at the University of Leeds said:

" This study examines the overall performance of the English NHS in managing surgically treated bowel cancer patients. It shows that some patients will always be at a greater risk than others but, despite this, the service is improving.
_The study has only been made possible by using routine NHS data submitted by hospitals. The quality of these data may vary slightly between hospitals but they are the best available to gain a national picture of the quality of care. Hospitals are paid on the basis of this information so it is in the interests of all that any inaccuracies are eliminated."

It is only as a result of this type of follow-up study that it is possible to identify which factors lead to the best patient outcomes and so improve the standard of care provided to all patients. It is, however, inevitable that variations and discrepancies in standards and practice will become be found in the process.

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