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Quality Improvement/Clinical Outcomes

E404: Do Outcomes Following Colorectal Resection for Colorectal Cancer Differ Between Flagship and Non-Flagship Hospitals in New York State?

Introduction: Hospitals are being merged to create large healthcare systems at a rapid pace. Whether outcomes following colorectal cancer resection at flagship hospitals vs non-flagship hospitals differ is unknown.

Methods: A 10-year (2010-2020) retrospective analysis of the New York Statewide Planning and Research Cooperative System (SPARCS) database was conducted. All adult patients with a primary resectable colorectal cancer diagnosis code and a subsequent colorectal resection were included. Emergency cases were excluded. Patients with a secondary malignant neoplasm of the respiratory or digestive systems, a primary genital organ cancer, or urinary system cancer were excluded. A list of hospital systems in New York state was created. Within each system, the hospital with the most colorectal resections was designated the “flagship” hospital and the others were designated “non-flagship” hospitals. Patient outcomes up to 30 days at flagship facilities were compared to outcomes at affiliated, non-flagship hospitals following their colorectal resection.

Results: In total, 57,663 patients were included in the study. There were 144 hospitals (31 flagship vs 113 non-flagship) that made up the 31 multi-hospital healthcare systems in New York state. Flagship facilities performed more procedures than non-flagship facilities on average (637 vs 177, p < 0.01). There was no difference in mortality at flagship vs non-flagship facilities (1.7% vs 1.6%, p = 0.41). There was no difference in the percentage of patients returning to the Emergency Department within 30 days (14.4% vs 14.7%, p = 0.84), post-operative blood transfusions (14.0% vs 17.3%, p = 0.73), or reoperation for hemorrhage control (0.5% vs 0.6%, p = 0.73) between flagship and non-flagship facilities. There were no differences in other postoperative complications between flagship and non-flagship hospitals: pneumonia (2.9% vs 3.3%, p = 0.57), acute renal failure (8.3% vs 7.7%, p = 0.32), myocardial infarction (1.3% vs 1.5%, p = 0.26), urinary tract infection (6.1% vs 5.9%, p = 0.99), and surgical site infection (3.2% vs 3.3%, p = 0.47). 

Conclusions: Flagship hospitals and non-flagship hospitals in New York state have similar outcomes following colorectal cancer resection. Patients with resectable non-metastatic colorectal cancer may not need to undergo oncologic resection at flagship hospitals to receive high-quality perioperative care. 

Learning Objectives:

  • State our operational definition of flagship and non-flagship hospitals for colorectal resections for primary resectable colorectal cancer
  • Analyze outcomes between flagship and non-flagship hospitals for colorectal resections for primary resectable colorectal cancer
  • Describe limitations of the New York State Statewide Planning and Research Cooperative (SPARCS) Database