London School of Hygiene & Tropical Medicine

The 30 day survival rate after bowel/rectal cancer surgery varies considerably among hospital trusts in England, even after taking account of factors likely to influence the risk of death, according to research published online in the journal Gut.

Bowel cancer is the third most common cancer in the UK, with more than 35,000 new cases diagnosed every year. And comparisons with comparable data from other countries show that the chances of surviving the disease in the UK are relatively poor.

The authors - including London School of Hygiene & Tropical Medicine Professor Michel Coleman and Dr Bernard Rachet - based their findings on risk-adjusted 30-day post-operative mortality among over 160,000 patients who underwent major bowel cancer surgery at one of 150 hospitals in England between 1998 and 2006.

Professor Coleman and Dr Rachet lead the Cancer Research UK Cancer Survival Group in the Department of Non-Communicable Disease Epidemiology.

The figures were adjusted for risk to take account of the complexity of the case mix, workload, and any underlying medical problems that would have affected the chances of survival after major surgery.

Unsurprisingly, the likelihood of dying after major surgery for bowel cancer was higher among older patients, especially those aged over 80; those with other underlying conditions, and those whose disease was more advanced.

Risk of death was also greater among those living in areas of deprivation and those who needed emergency surgery.

Women were significantly less likely to die after surgery than men, as were those who underwent surgery for rectal rather than bowel cancer.

Overall, the proportion of people who died within 30 days of major surgery for bowel cancer was just under 7% (6.7%; 10, 704 deaths) across all hospital trusts in England undertaking the procedure.

This percentage fell over time, dropping from 6.8% in 1998 to 5.8% in 2006. But while one trust had significantly better outcomes, three trusts had significantly worse outcomes over time, two of which were foundation trusts.

“The postoperative mortality of 6.7% seen in this study is notably higher than that previously reported for the UK,” comment the authors, who add that the figures are “significantly higher than that reported from other countries.”

“This suggests that either the NHS may have fundamentally worse postoperative outcomes than some other comparable health services or that the operative risk of patients differs between countries,” they say.

“Understanding and minimising these differences could significantly reduce the number of premature deaths caused by the disease across the country,” they conclude, adding that the decision to publicise death rates after cardiothoracic surgery has demonstrably improved survival rates among these patients.

• Thirty day postoperative mortality after colorectal cancer surgery in England: Online First doi 10.1136/gut.2010.232181