Inter-hospital variation in resection rates of colon cancer in the Netherlands: A nationwide study

Introduction: Hospital of diagnosis is shown to have an impact on the probability of undergoing a resection in different types of gastrointestinal cancer. The aim of this study was to investigate the inter-hospital variation in resection rates and its impact on survival among patients with non-metastatic colon cancer. Methods: All patients diagnosed with non-metastatic colon cancer between 2009 and 2014 were selected from the Netherlands Cancer Registry. Multilevel logistic regression was used to examine the variation in resection rates among hospitals. The effect of variation in surgical resection on overall survival was assessed using Cox regression analyses. Relative survival was used as an estimate for disease-specific survival. Results: 38164 patients, treated in 95 different hospitals, were included in the analysis. After adjustments, resection rates varied between hospitals from 88 to 99%. This variation increased among patients older than 75 years, from 79 to 98%. Crude overall 5-year survival was 64%. After adjustment, no significant difference in overall or relative survival between hospitals with higher and lower resection rates was observed. Conclusion: Resection rates are important to consider when interpreting hospital outcomes. There is a significant variation in resection rates in patients with non-metastatic colon cancer among hospitals in the Netherlands. This variation increases in the elderly. No significant effect on survival was found. This could imply that undertreatment may play a role as well as that some patients might not benefit from surgery.

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