Socioeconomic Factors Influence Major Cancer Surgery Outcomes

Research reveals the relationship between socioeconomic status and failure to rescue patients following complications from major cancer surgery

medwireNews: The risk of death following complications from major surgery for cancer is significantly associated with the socioeconomic status (SES) of the hospital’s patients, say US investigators.

They examined variation in the rate of failure to rescue (FTR) after one or more major complications using hospital data for 596,222 US cancer patients who underwent oesophagectomy, pancreatectomy, partial or total gastrectomy, colectomy, cystectomy or lung surgery between 2003 and 2007.

Analysis revealed that patients in the lowest quintile of SES - defined using wealth, income, education and employment status - had a small but significant increase in the risk of complications following cancer surgery compared with those in the highest quintile, at 25.6% versus 23.8%.

In addition, significantly higher rates of mortality (10.2 vs 7.7%) and FTR after one or more major complications (26.7 vs 23.2%) were observed comparing patients in the lowest with those in the highest quintile, say Amir Ghaferi, from the University of Michigan in Ann Arbor, and co-authors.

Moreover, the risk of FTR after a major complication was significantly associated with the proportion of a hospital’s patients who had a low SES, with this risk affecting all of its patients, regardless of an individual patient’s SES.

The crude odds ratio of FTR after surgery was 1.2 for patients in the lowest versus highest quintile, and this was significant for all operations except cystectomy. Adjusting for patient characteristics did not change the significance, whereas adjusting for the hospital SES effect reduced the FTR and the risk was no longer significant except for colectomy.

Writing in JAMA Surgery, the researchers note that FTR rates have been attributed to hospital characteristics, such as teaching status and intensive care staffing, but say that “it is likely that some combination of hospital resources, attitudes, and behaviors is what yields an environment most conducive to the timely recognition and effective management of complications.”

Amir Ghaferi et al therefore conclude: “Future national hospital quality improvement initiatives can use these findings as evidence to support efforts to improve rescue rates in poorly performing hospitals, as part of a broad strategy directed toward effectively reducing socioeconomic disparities in cancer surgery mortality.”


Reames B, Birkmeyer N, Dimick J, et al. Socioeconomic disparities in mortality after cancer surgery – Failure to rescue. JAMA Surg 2014; Advance online publication 12 March. doi:10.1001/jamasurg.2013.5076

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