• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
Click here to emailClick here to printClick here to share

Unplanned Hospital Visits After Surgery

 
Measure Desired Direction As of this Report
Percentage of patients with an unplanned hospital visit after lung surgery Black Arrow Down Yellow Arrow Null
Percentage of patients with an unplanned hospital visit after breast, colorectal, prostate and thyroid surgery Black Arrow Down Yellow Arrow Null
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Approximately one eighth to one quarter of patients who undergo lung, prostate, colorectal, breast or thyroid surgery have an unplanned hospital visit following cancer surgery. Cancer Care Ontario is actively monitoring Ontario’s hospitals in an effort to improve surgery quality in Ontario.

What is lung, prostate, colorectal, breast or thyroid cancer surgery?

  • Cancer surgery is commonly used to help treat many types of cancer, including lung, prostate, colorectal, breast and thyroid cancers.
  • Lung cancer surgery is a preferred treatment option for non-small cell lung cancer (NSCLC)1. Whenever Surgery is not a typical treatment option for small cell lung cancer2.
    • Surgeries (resections) to remove lung cancer can fall into the following categories2,3:
      • pneumonectomy (the removal of an entire lung);
      • lobectomy (the removal of 1 lobe) or bilobectomy (the removal of 2 lobes of the lung);
      • segmentectomy (the removal of an anatomic division of a particular lobe of the lung); and
      • wedge resection (the removal of a small portion of a lobe of the lung that targets a localized portion of disease).
    • The data below specifically describe patients who have undergone a lobectomy or bilobectomy, since these are the most common procedures performed
  • Prostate cancer surgery is a common treatment option for patients with localized prostate cancer4.
    • Radical prostatectomy is the surgical procedure used to treat prostate cancer, and it involves removing the prostate gland and some of the tissue surrounding it5.
    • The data for prostate surgery includes patients who underwent a radical prostatectomy.
  • Surgery is the most common curative treatment method for localized colorectal cancer.
    • The goals of colorectal cancer surgery are to a) remove cancer completely, b) remove adjacent lymph nodes and c) rejoin the bowel to provide normal (or near normal) function, when possible. Surgeries to remove colorectal cancer depend on a number of factors, such as tumour location and size, timing of surgery, cancer stage, and patient status and preferences. These surgeries can fall into the following categories6:
      • partial colectomy (removal of part of the colon e.g. right or left hemicolectomy);
      • abdominoperineal resection (removal of the anus, rectum and sigmoid colon);
      • proctosigmoidectomy (removal of the diseased section of the rectum and sigmoid colon);
      • total abdominal colectomy (removal of the entire large intestine); and
      • total proctocolectomy (an extensive operation that involves removal of both the rectum and the colon).
    • The section below includes the following surgeries listed above.
  • Surgery is a common treatment option for patients with localized breast cancer.
    • There are several surgical treatment options for the removal of breast cancer, including:
      • lumpectomy (removal of the cancer and a margin of breast tissue surrounding the affected area)
      • mastectomy (complete removal of the breast and nipple)
    • Following breast cancer surgery, some patients who have had a mastectomy may choose to have a breast reconstruction. Breast reconstruction may be performed at the same time as the breast cancer surgery (immediate reconstruction) or at a later date (delayed reconstruction), depending on the patients’ medical condition, and their personal preference for reconstruction.
    • The data below includes patients who had a breast cancer surgery (lumpectomy, mastectomy, sentinel lymph node biopsies and axillary lymph node dissections), as well as patients who had immediate reconstruction following mastectomy.
  • Surgery is the main treatment for thyroid cancer, except for certain anaplastic thyroid cancers.
    • The primary goal of thyroid cancer surgery is to remove the tumour and if required, some surrounding healthy tissue.
    • The main types of thyroid cancer surgery are:
      • partial thyroidectomy (removal of a single lobe of the thyroid gland with or without removal of the thyroid isthmus and the medial portion of the contralateral lobe)
      • total thyroidectomy (removal of the entire thyroid gland)
    • In conjunction with the thyroidectomy procedure, removal of adjacent lymph nodes, a lymphadenectomy (neck dissection) may be performed if there is the possibility that cancer has spread to the lymph nodes in the neck.
    • The data below includes patients who had a partial or total thyroidectomy, with or without a neck dissection.

What is an unplanned visit after cancer surgery?

  • An unplanned visit occurs when a patient returns to the emergency department (ED) visit or is readmitted directly to the hospital within 30 days of a cancer surgery.
Figure 1: Percentage of patients who had lung surgery and an unplanned emergency department visit or were readmitted within 30 days after surgery, fiscal year 2014/15 - 2015/16

Description of Flow Chart: Unplanned Hospital Visits after Surgery — Figure 1: Percentage of patients who had lung surgery and an unplanned emergency department visit or were readmitted within 30 days after surgery, fiscal year 2014/15 - 2015/16

The figure is a flow chart with 19 labeled boxes linked by lines.

Here the flow chart is presented as lists in which the connections are listed beneath each box label. Each box label includes the relevant number and percentage of cancer patients who had a lung resection.

  1. Patients who had lung surgery for cancer treatment: N=5398
    1. Connects to Pneumonectomy: N=228 (4.2%)
      1. Connects to ED visit only: N=39 (17.1%)
      2. Connects to No unplanned visit: N=164 (71.9%)
      3. Readmitted: N=25 (11.0%)
        1. Connects to Via ED: N=†
        2. Connects to Direct readmission: N=†
    2. Connects to Lobectomy/Bilobectomy: N=2769 (51.3%)
      1. Connects to ED visit only: N=448 (16.2%)
      2. Connects to No unplanned visit: N=2157 (77.9%)
      3. Readmitted: N=164 (5.9%)
        1. Connects to Via ED: N=136 (82.9%)
        2. Connects to Direct readmission: N=28 (17.1%)
    3. Connects to Segmentectomy/Wedge resection: N=2401 (44.5%)
      1. Connects to ED visit only: N=377 (15.7%)
      2. Connects to No unplanned visit: N=1885 (78.5%)
      3. Readmitted: N=139 (5.8%)
        1. Connects to Via ED: N=110 (79.1%)
        2. Connects to Direct readmission: N=29 (20.9%)

Report date: December 2016
Data source: CIHI-DAD, CIHI-NACRS
Prepared by: Analytics and Informatics, Cancer Care Ontario

Note: Numbers shown are for Ontario. Groups are mutually exclusive. Dashed-line frame denotes data included in Figure 2. † Values have been suppressed due to small cell counts.

click to close graph
Close Graph
Unplanned Hospital Visits After Surgery

Description of Flow Chart: Unplanned Hospital Visits after Surgery — Figure 3: Percentage of patients who had breast, colorectal, prostate or thyroid surgery and an unplanned emergency department visit or who were readmitted within 30 days after surgery, fiscal year 2014/15 - 2015/16

The figure is a flow chart with 8 labeled boxes linked by lines.

Here the flow chart is presented as lists in which the connections are listed beneath each box label. Each box label includes the relevant number and percentage of cancer patients who had a breast, colorectal, prostate or thyroid resection.

  1. Patients who had surgery for cancer treatment*:
    —N=59,917
    1. Connects to ED visit only:
      — N=7,308 (12%)
    2. Connects to Readmitted:
      — N=2,788 (5%)
    3. Connects to No unplanned hospital visit:
      — N=49,821 (83%)

  2. Patients who had surgery for cancer treatment*:
    — Breast: N=33,177
    — Colorectal N=13,298
    — Prostate: N=4751
    — Thyroid N=8,691

    1. Connects to ED visit only:
      — Breast N=3,577 (11%)
      — Colorectal N=1,822 (14%)
      — Prostate N=1,031 (22%)
      — Thyroid N=879 (10%)

    2. Connects to Readmitted:
      — Breast N=1,210 (4%)
      — Colorectal N=1,212 (9%)
      — Prostate N=144 (3%)
      — Thyroid N=222 (3%)

    3. Connects to No unplanned hospital visit:
      — Breast N=28,390 (86%)
      — Colorectal N=10,264 (77%)
      — Prostate N=3,576 (75%)
      — Thyroid N=7,591 (87%)

Report date: December 2016
Data source: CIHI-DAD, CIHI-NACRS
Prepared by: Analytics and Informatics, Cancer Care Ontario

Note: Numbers shown are for Ontario. Groups are mutually exclusive. Dashed-line frame denotes data included in Figure 4. † Values have been suppressed due to small cell counts.

What do the results show?

Of patients who underwent lung surgery for a lobectomy or bilobectomy, 22% had an unplanned ED visit or were readmitted to hospital within 30 days following surgery (Figures 1 and 2).

  • Patients described in these figures include those who had lobectomies or bilobectomies.
  • Among the patients who underwent lung surgery for lobectomies or bilobectomies for the 2 year period fiscal year 2014/15 through fiscal year 2015/16, 22% had an unplanned hospital visit, with 6% of patients being readmitted to the hospital and 16% having an ER visit only.
  • ED visits for lobectomy or bilobectomy patients varied significantly between designated thoracic surgery centres, with St. Joseph’s Health Care Hamilton and Trillium Health Partners having the lowest rates of unplanned hospital visits (9%). Thunder Bay Hospital had the highest rate (39%).
  • Readmission rates ranged from 1% at Trillium Health Partners to 9% at South Lake Regional Health Centre.
  • The unplanned hospital visit rate in non-designated thoracic centres is 54%, however, it is important to note that the volumes are very low as the vast majority of thoracic resections in Ontario are performed at one of 15 designated thoracic surgery centres.

Percentage of patients who visited the ED or were readmitted to hospital within 30 days following cancer surgery varied by disease site (Figures 3 and 4).

  • The provincial average of patients who visited the hospital within 30 days after cancer surgery for the 2 year period fiscal year 2014/15 through fiscal year 2015/16 for breast cancer was 14%, colorectal at 23%, prostate at 25%, and thyroid at 13%.
  • Prostate cancer patients had the highest rate of ED visits of the 4 disease sites (22%), whereas colorectal patients had the highest readmission rate of the 4 disease sites (9%).
  • There was some regional variation for unplanned hospital visits across all four disease sites.
  • About 10% of patients from Toronto Central LHIN who had breast cancer surgery had an unplanned hospital visit compared to 27% in North West LHIN.
  • Both Central West and Mississauga Halton LHINs had the lowest reported rate of unplanned hospital visits within 30 days following colorectal (17%) and thyroid surgery (8% and 9% respectively).
  • North West LHIN had the highest percentage of reported unplanned visits across all four disease sites with breast (27%), colorectal (37%), prostate (51%) and thyroid (20%).
  • Unplanned hospital visits also are reported for patients undergoing chemotherapy treatment and during radiation treatment.

Why is this important to patient care?

  • Looking at unplanned visits after lung, prostate, colorectal, breast and thyroid cancer surgery allows us to monitor the complications and adverse events following cancer surgeries.
  • There may be some complications after cancer surgery that require the patient to return to the hospital, but others may be appropriately managed in different ways. Common problems include pain, infections, bleeding, blood clots and slow recovery of other body functions7.

Find out more:

View Notes

  1. Park BJ, Altorki NK. Diagnosis and management of early lung cancer. Surg Clin N Am. 2002; 82(3):457–76.
  2. Darling G, Nenshi R, Schultz SE, Gunraj N, Wilton AS, Simunovic M, et al. Surgery for lung cancer. In: Urbach DR, Simunovic M, Schultz SE, editors. Cancer surgery in Ontario: ICES atlas. Toronto: Institute for Clinical Evaluation Sciences, 2008.
  3. Nakamura H, Kazuyuki S, Kawasaki N, Taguchi M, Kato H. History of limited resection for non-small cell lung cancer. Ann Thor Card Surg. 2005; 11(6):356–62.
  4. Klein EA. Radical prostatectomy for localized prostate cancer. In Post T, editor. UpToDate. Waltham (Mass): UpToDate; 2016.
  5. Schaeffer EM, et al. Radical retropubic and perineal prostatectomy. In Wein AJ, et al., editors. Campbell-Walsh Urology, 10th ed. Vol. 3. Philadelphia: Saunders; 2012. p. 2801–2829.
  6. WebMD [Internet]. WebMD: c2005–2016. Colorectal cancer health center; 2015 Feb 1. Available from: http://www.webmd.com/colorectal-cancer/surgery-treat-colorectal-cancer?page=3.
  7. Cancer.org [Internet]. American Cancer Society: c2016. A guide to cancer surgery; 2014 Sept 29. Available from: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/surgery/surgery-risks-and-side-effects.