Abstract
Background
Colon cancer requires interdisciplinary care with quality of initial surgical treatment
being a major prognostic factor. Implementation of quality standards based on structural
and procedural indicators in routine care via certification (Germany) or accreditation
(USA) is an established quality assurance method. However, evidence on effects is
scarce. We undertook a population-based cohort study to investigate the effectiveness
of colon cancer care in certified vs non-certified hospitals.
Materials and methods
We utilized data of a large statutory health insurance including in- and outpatient
data from 2005 to 2015 of >2 million individuals from Saxony, Germany. Case definitions
were based on diagnosis, medical procedures and prescriptions. Patients treated in
certified hospitals (CH) were compared to patients treated in non-certified hospitals
(NCH) using logistic and Cox regression models adjusting for relevant confounders
concerning overall survival (OS), disease-specific survival (DSS), 30-day mortality,
recurrence, complications and second resections within 6 months after first resection
(SR).
Results
Overall, 6186 patients with incident colon cancer undergoing surgery were identified
(mean age 74.1 ± 11.0 years, 51.1% male) with 2120 (34.3%) patients treated in a CH.
Confounder-adjusted regression models indicated positive effects in CH on OS (HR = 0.90,
95%CI: 0.83–0.97), DSS (HR = 0.71, 95%CI: 0.57–0.88), 30-day mortality (OR = 0.69,
95%CI: 0.55–0.87) and SR (OR = 0.51, 95%CI: 0.30–0.87). These results remained stable
after adjustment for hospital volume. 30-day mortality in 2014 was 41% lower in CH
(7.4%) compared to NCH (12.6%).
Conclusions
This study indicates that the implementation and assurance of evidence-based quality
standards has substantial positive effects on various patient-relevant outcomes in
colon cancer care.
Keywords
Abbreviations:
AIC (Akaike information criterion), ATC (Anatomical Therapeutic Chemical code), CH (Certified hospital), DGAV (“Deutsche Gesellschaft für Allgemein-und Viszeralchirurgie” (German Society for General and Visceral surgery)), DKG (“Deutsche Krebsgesellschaft” (German Cancer Society)), DSS (Disease-specific survival), EBM (“Einheitlicher Bewertungsmaβstab” (Uniform Value Scale)), HR (Hazard Ratio), NCH (Non-certified hospital), OPS (“Operationen-und Prozedurenschlüssel” (German modification of the International Classification of Procedures in Medicine)), OR (Odds Ratio), OS (Overall survival), PZN (pharmaceutical registration numbers), SR (second resections within 6 months after first resection), UICC (Union international contre le cancer), 95%CI (95% confidence intervals)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 17, 2018
Accepted:
May 9,
2018
Identification
Copyright
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
