Study: Significant variation found in results of bowel cancer surgery across English NHS hospitals

There is worrying variation in the results of bowel cancer surgery across NHS hospitals in England with some having many more patient deaths immediately after surgery than others, according to new research funded by Cancer Research UK and published today in Gut.

In this study, researchers from the University of Leeds looked at all patients who had major surgery to remove their bowel cancer over a nine year period between 1998 and 2006 in the English NHS and examined the numbers who survived 30 days after their operation.

The Cancer Research UK funded researchers found that overall 6.7 per cent of patients (10,704) died within 30 days of their surgery - a proportion which is higher than other countries such as Scandinavia, Canada and the USA which range from 2.7 per cent to 5.7 per cent. But there was a reduction over time in the percentage of deaths occurring. In 1998, almost 6.8 per cent of patients died within 30 days of their bowel cancer surgery, but this had declined to almost 5.8 per cent by 2006.

Deaths within 30 days following surgery in England were higher in certain groups including men, the elderly, people who were 'worse off', had advanced cancer, presented as emergencies, or those who also had other diseases.

And, despite taking into account these factors, there was also variation between NHS hospital trusts with five hospitals in the 2003-2006 having significantly higher percentages of deaths within 30 days following surgery and three having far fewer deaths.

The NCIN has used this new methodology to examine the latest data from these five poorest performing trusts, as well as the three best trusts, in 2007-08. This preliminary data shows that all of the five trusts performed better from 2007-08. The results of all hospitals in England are being published online by the National Cancer Intelligence Network.

Paul Finan, study author and consultant colorectal surgeon, said: "It's very encouraging to see that overall the 30-day postoperative mortality rate is decreasing across the country But, having adjusted for those factors that can affect post-operative mortality, it is a concern that there is significant variation between hospitals.

"Understanding why this has occurred is a complex matter and is now a priority for the National Cancer Intelligence Network and the wider cancer community. It's vital to learn from the Trusts with very low post-operative mortality so that we can identify and spread best practice across the NHS and so help to reduce post-operative mortality further."

Eva Morris, study author and Cancer Research UK Bobby Moore fellow at the University of Leeds, said: "This study examines the overall performance of the English NHS in managing surgically treated bowel cancer patients. It shows that some patients will always be at a greater risk than others but, despite this, the service is improving.

"The study has only been made possible by using routine NHS data submitted by hospitals. The quality of these data may vary slightly between hospitals but they are the best available to gain a national picture of the quality of care. Hospitals are paid on the basis of this information so it is in the interests of all that any inaccuracies are eliminated."

Dr Lesley Walker, Cancer Research UK's director of cancer information, said: "It's vitally important that trusts and networks can compare their performance with others because that will help to improve standards of cancer care as they strive to be among the best in the country."

"Thirty day mortality data following bowel cancer surgery is one of the key measures used by surgeons and the cancer care teams to monitor their progress. The evidence provided here asks a number of important questions which we now need to answer. Getting the best UK cancer data that we can is crucial to any meaningful analysis of our record on cancer and must be a priority for the NHS."