Outcomes After Rectal Cancer Surgery: A Population-Based Study Using Quality Indicators

Quality indicators are increasingly being used to measure the safety of cancer treatments. We examined factors associated with poorer outcomes after major resection for rectal cancer over time. We linked population-based cancer registry and cancer-related procedure data for rectal cancer cases over a 15-year period. Multivariable logistic regression models were used to examine factors associated with 30- and 90-day postoperative mortality, and overall survival (OS) was estimated using the Kaplan-Meier survival function. The study included 9,222 patients who had major resection for invasive rectal cancer. Thirty-day and 90-day mortality were 2.1% and 3.8%, respectively. Risk of 30-day mortality was elevated in older patients (p < .001); patients with >= 2 comorbidities (p < .001); and those admitted as an emergency (p < .001). An approximate 45% reduction in 30-day mortality (p = .01) was observed over time. Two-year OS was 81.5%, again with significant improvements observed over time (p < .001). No significant association was observed between hospital volume and mortality or 2-year survival. A reduction in rates of postoperative mortality and improved 2-year OS were observed over time. Quality indicators are a valuable tool to monitor clinical outcomes over time and as a means of improving clinical care for all patients.