• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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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 prostate surgery Black Arrow Down Grey Arrow Null
Percentage of patients with an unplanned hospital visit after colorectal surgery Black Arrow Down Grey Arrow Null
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Approximately one quarter of patients who undergo lung, prostate and colorectal 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 or colorectal cancer surgery?

  • Cancer surgery is commonly used to help treat many types of cancer, including lung, prostate and colorectal cancers.
  • Lung cancer surgery is a potential treatment option for non-small cell lung cancer (NSCLC)1. 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.
  • 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 include patients who had 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. 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);
      • right colectomy (where the right side of the colon is removed) or ileocolectomy (last segment of the small intestine is removed);
      • 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.

What is an unplanned visit after cancer surgery?

  • An unplanned visit occurs when a patient returns for an 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 (ED) visit or who were readmitted within 30 days after surgery, FY2013/2014–FY2014/2015

Description of Flow Chart: Figure 1. Unplanned Hospital Visits After Lung Cancer Surgery — Percentage of patients who had lung surgery and an unplanned ED visit or were readmitted within 30 days after surgery, April 2013-March 2015

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=5165
    1. Connects to Pneumonectomy: N=268 (5%)
      1. Connects to ED visit only: N=43 (16%)
      2. Connects to No unplanned hospital visit: N=191 (71%)
      3. Readmitted: N=34 (13%)
        1. Connects to Via ED: N=26 (10%)
        2. Connects to Direct readmission: N=8 (3%)
    2. Connects to Lobectomy/Bilobectomy: N=2621 (51%)
      1. Connects to ED visit only: N=438 (17%)
      2. Connects to No unplanned hospital visit: N=2016 (77%)
      3. Readmitted: N=167 (6%)
        1. Connects to Via ED: N=127 (5%)
        2. Connects to Direct readmission: N=40 (2%)
    3. Connects to Segmentectomy/Wedge resection: N=2276 (44%)
      1. Connects to ED visit only: N=317 (14%)
      2. Connects to No unplanned hospital visit: N=1801 (79%)
      3. Readmitted: N=158 (7%)
        1. Connects to Via ED: N=110 (5%)
        2. Connects to Direct readmission: N=48 (2%)

Report date: February 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.

click to close graph
Close Graph
Figure 3. Percentage of patients who had prostate surgery and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery, FY2013/2014–FY2014/2015

Description of Flow Chart: Figure 3. Unplanned Hospital Visits after Prostate Cancer Surgery — Percentage of patients who had prostate surgery and an unplanned ED visit or were readmitted within 30 days after surgery, April 2013-March 2015

The figure is a flow chart with 6 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 prostate resection.

  1. Patients who had prostate surgery for cancer treatment: N=4,792
    1. Connects to ED visit only: N=1,057 (22%)
    2. Connects to No unplanned hospital visit: N=3,577 (75%)
    3. Readmitted: N=158 (3%)
      1. Connects to Via ED: N=142 (3%)
      2. Connects to Direct readmission: N=16 (0.3%)

Report date: February 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.

Figure 5. Percentage of patients who had colorectal surgery and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery, FY2013/2014–FY2014/2015

View text description of chart

Description of Flow Chart: Unplanned Hospital Visits after Colorectal Cancer Surgery — Percentage of patients who had colorectal surgery and an unplanned emergency department (ED) visit or who were readmitted within 30 days after surgery

The figure is a flow chart with 13 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 colorectal resection.

  1. Patients who had colorectal surgery for cancer treatment: N=13,767
    1. Connects to Colon: N=9,653 (70%)
      1. Connects to ED visit only: N=1,215 (13%)
      2. Connects to No unplanned visit: N=7,622 (79%)
      3. Readmitted: N=816 (8%)
        1. Connects to Via ED: N=643 (7%)
        2. Connects to Direct readmission: N=173 (2%)
    2. Connects to Rectal: N=4,114(30%)
      1. Connects to ED visit only: N=705 (17%)
      2. Connects to No unplanned visit: N=2,968 (72%)
      3. Readmitted: N=441 (11%)
        1. Connects to Via ED: N=368 (9%)
        2. Connects to Direct readmission: N=73 (2%)

Report date: March 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 6 and 7.

What do the results show?

Of patients who underwent lung surgery for a lobectomy or bilobectomy, 23% made 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 undergo lung surgery for lobectomies or bilobectomies from FY2013/2014 to FY 2014/2015, 23% have an unplanned hospital visit, with 6% of patients being readmitted to the hospital.
  • ED visits for lobectomy or bilobectomy patients varied significantly between designated thoracic surgery centres, with St. Mary’s General Hospital and St. Joseph’s Health Care Hamilton having the lowest rates of unplanned hospital visits (9%). Thunder Bay Hospital had the highest (35%).
  • Readmission rates ranged from 2% at Trillium Health Partners to 11% at South Lake Regional Health Centre.

One quarter of patients who underwent prostate cancer surgery visited the ED or were readmitted to hospital within 30 days following surgery (Figures 3 and 4).

  • One quarter of patients who had prostate surgery from FY2013/2014 to FY2014/2015 visited the hospital within 30 days following surgery, with 22% of those only visiting the ED and 3% being readmitted either via the ED or directly.
  • There was some regional variation for ED visits only, with Mississauga Halton Local Health Integration Network (LHIN) having 17% of prostate cancer surgery patients only visiting the ED compared to 33% in North East LHIN.
  • Readmission rates ranged from 1% in North Simcoe Muskoka LHIN to 6% in North East LHIN.

Almost one third of patients who had rectal cancer surgery and almost one quarter of patients who had colon cancer surgery had an unplanned hospital visit within 30 days following surgery (Figures 5, 6 and 7).

  • Among the patients who received colon cancer surgery from FY 2013/2014 to FY 2014/2015, 21% had an unplanned hospital visit within 30 days of surgery, with 8% of those patients being readmitted to the hospital.
  • In contrast, 28% of rectal cancer surgery patients had an unplanned hospital visit, with 11% of those patients being readmitted to the hospital.
  • There was significant regional variation in the rate of unplanned hospital visits following colon cancer surgery, with 34% of colon cancer surgery patients in North West LHIN having an unplanned hospital visit, compared to 17% in Central West LHIN.
  • Regional variation was even greater for rectal cancer patients, with up to 34% of patients only visiting the ED within 30 days of surgery, and as many as 19% being readmitted.
  • Unplanned hospital visits are also reported on during a course of chemotherapy treatment and during radiation treatment.

Why is this important to patient care?

  • Looking at unplanned visits after lung, prostate and colorectal 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.
  • This measures unplanned hospital visits following 30 days of cancer surgery. Long-term side effects, however, depend on the specific type of surgery that was done. For example, urinary incontinence and impotence are complications of most concern to men who undergo prostatectomy4.
  • A patient-centered discharge tool targeted at readmission prevention is critical for surgical cancer patients.

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.