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Reoperations after Cancer Surgery

Key findings

Following cancer surgery, a small proportion of patients may develop a complication that requires an unplanned reoperation within 30 days of their original cancer resection. Approximately 2% of lung cancer patients, 5% of colorectal cancer patients, 7% of bladder cancer and 1% of breast, prostate and thyroid cancer patients had an unplanned reoperation within 30 days after cancer surgery.

Measure:  Percentage of reoperations after cancer surgery for patients diagnosed with lung cancer

 

Desired Direction:

 

An image of an arrow pointing downwards. This indicates that desired direction for this action is downwards.

 

As of this Report:

 

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Reoperation after cancer surgery

  • Cancer surgery is commonly used to help treat many types of cancer, including bladder, breast, colorectal, lung, prostate and thyroid cancers.
  • Unplanned reoperations after surgery may be due to a number of factors, such as post-operative complications [1].
  • Measuring the rate of unplanned reoperations within 30 days of original cancer resection monitors the quality of cancer surgeries.

Figure 1. Percentage of reoperations after lung surgery for patients diagnosed with lung cancer, fiscal year 2015/2016 to fiscal year 2016/2017

More information regarding the methodology is available.

Report date: December 2017

Data source: CIHI-DAD

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. Due to rounding, percentages may not add up to 100%.

Figure 2. Percentage of reoperations after lobectomy or bilobectomy for patients diagnosed with lung cancer, fiscal year 2015/2016 to fiscal year 2016/2017, by designated centre of surgery

More information regarding the methodology is available.

Report date: December 19, 2017

Data source: CIHI-DAD

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Figure 3. Percentage of reoperations after bladder, breast, colorectal, prostate and thyroid surgeries for cancer patients, fiscal year 2015/2016 to fiscal year 2016/2017

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.5.b, Methodology 2.2.c, Methodology 2.2.d, Methodology 2.2.e and Methodology 2.2.f.

Report date: December 2017

Data source: CIHI-DAD, CIHI-NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note: 

  1. Numbers shown are for Ontario. Groups are mutually exclusive
  2. Due to rounding, percentages may not add up to 100%.

Figure 4. Percentage of reoperations after bladder, breast, colorectal, prostate and thyroid surgeries for cancer patients, fiscal year 2015/2016 to fiscal year 2016/2017, by Local Health Integration Network (LHIN) of surgery

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.5.b, Methodology 2.2.c, Methodology 2.2.d, Methodology 2.2.e and Methodology 2.2.f.

Report date: December 19, 2017

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Figure 5. Number of reoperations after cancer surgery, fiscal year 2015/2016 to fiscal year 2016/2017, by disease site

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.5.b, Methodology 2.2.c, Methodology 2.2.d, Methodology 2.2.e and Methodology 2.2.f.

Report date: January 19, 2018

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 2. Percentage of reoperations after lobectomy or bilobectomy for patients diagnosed with lung cancer, fiscal year 2015/2016 to fiscal year 2016/2017, by designated centre of surgery

Designated centre of surgery Reoperations (%) Lower confidence interval (%) Upper confidence interval (%)
Province 1.9 1.4 2.5
WRH 1.6 0.0 5.7
LHSC 2.2 0.1 4.4
SMGH 1.9 0.0 4.4
STJOEHAM 0.8 0.0 1.7
OSLERHC 4.2 0.0 8.8
THP 1.6 0.0 4.3
STJOETOR 4.1 0.0 8.6
UHN 2.7 0.9 4.5
TEGH 3.2 0.8 5.6
SLRHC 1.8 0.0 4.8
LAKE 0.3 0.0 1.2
KGH/HDH 0.0 0.0 0.9
OTTAWA 1.3 0.0 2.8
HSN 4.8 0.7 9.0
TBH 0.0 0.0 1.0
NON-DC 3.2 0.0 11.1

Report date: December 19, 2017

Data source: CIHI-DAD

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 4. Percentage of reoperations after bladder, breast, colorectal, prostate and thyroid surgeries for cancer patients, fiscal year 2015/2016 to fiscal year 2016/2017, by Local Health Integration Network (LHIN) of surgery

LHIN+A6:Q21 Acronym Percentage of reoperations after bladder surgery Lower confidence interval after bladder surgery Upper confidence interval after bladder surgery Percentage of reoperations after breast surgery Lower confidence interval after breast surgery Upper confidence interval after breast surgery Percentage of reoperations after colorectal surgery Lower confidence interval after colorectal surgery Upper confidence interval after colorectal surgery Percentage of reoperations after prostate surgery Lower confidence interval after prostate surgery Upper confidence interval after prostate surgery Percentage of reoperations after thyroid surgery Lower confidence interval after thyroid surgery Upper confidence interval after thyroid surgery
Province ON 7.4 5.9 8.8 1.2 1.0 1.3 5.0 4.6 5.4 1.0 0.7 1.3 1.1 0.9 1.4
Erie St. Clair ESC 1.9 0.0 6.6 0.8 0.3 1.2 6.1 4.2 8.1 0.0 0.0 0.2 0.9 0.0 1.9
South West SW 5.5 1.7 9.3 2.3 1.7 2.9 4.1 2.9 5.2 1.6 0.4 2.8 1.3 0.2 2.3
Waterloo Wellington WW 10.5 0.0 21.6 1.3 0.7 2.0 5.7 3.8 7.5 0.0 0.0 0.9 0.6 0.0 1.7
Hmltn-Ngr-Hldmnd-Brnt HNHB 3.6 0.5 6.6 1.0 0.6 1.3 4.7 3.7 5.8 1.3 0.4 2.2 1.7 0.4 2.9
Central West CW 0.0 0.0 1.4 0.6 0.1 1.0 3.7 1.8 5.5 0.0 0.0 0.3 0.9 0.0 1.9
Mississauga Halton MH 18.2 7.1 29.3 0.8 0.4 1.1 3.6 2.3 4.9 0.9 0.0 2.3 0.7 0.0 1.4
Toronto Central TC 5.8 3.1 8.5 1.3 1.0 1.6 5.3 4.2 6.4 0.9 0.3 1.5 1.3 0.8 1.8
Central Cen 8.2 1.8 14.7 0.7 0.4 1.0 5.7 4.5 7.0 2.4 0.8 4.0 0.9 0.2 1.6
Central East CE 5.6 0.8 10.4 1.3 0.9 1.7 4.6 3.5 5.8 0.4 0.0 1.0 1.0 0.3 1.7
South East SE 13.5 1.1 25.9 1.2 0.5 1.9 4.3 2.5 6.2 0.0 0.0 0.4 0.9 0.0 2.9
Champlain Ch 12.2 6.2 18.2 0.9 0.5 1.2 5.5 4.2 6.8 1.4 0.3 2.5 1.0 0.0 1.9
North Simcoe Muskoka NSM 12.5 0.0 27.8 1.9 1.0 2.7 5.5 3.4 7.6 0.0 0.0 0.3 0.9 0.0 2.3
North East NE 8.1 0.0 18.3 1.7 1.0 2.4 5.7 3.8 7.6 0.7 0.0 2.4 2.5 0.5 4.5
North West NW 31.3 5.4 57.1 1.1 0.0 2.2 5.8 2.5 9.1 0.0 0.0 1.4 0.8 0.0 2.8

Report date: December 19, 2017

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 5. Number of reoperations after cancer surgery, fiscal year 2015/2016 to fiscal year 2016/2017, by disease site

Province Bladder Breast Colorectal Prostate Thyroid
ON 94 390 646 49 95

Report date: January 19, 2018

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Figure 1. Percentage of reoperations after lung surgery for patients diagnosed with lung cancer, fiscal year 2015/2016 to fiscal year 2016/2017

The figure is a flow chart with 7 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=5515
    1. Connects to Pneumonectomy: N=223 (4.04%)
      1. Connects to Reoperations: N=12 (5.38%)
    2. Connects to Lobectomy/Bilobectomy: N=2833 (51.37%)
      1. Connects to Reoperations: N=55 (1.94%)
    3. Connects to Segmentectomy/Wedge resection: N=2459 (44.59%)
      1. Connects to Reoperations: N=45 (1.83%)

Figure 3. Percentage of reoperations after bladder, breast, colorectal, prostate and thyroid surgeries for cancer patients, fiscal year 2015/2016 to fiscal year 2016/2017

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 breast, bladder, colorectal, prostate or thyroid resection.

  1. Patients who had cancer surgery: N=61,090
    1. Connects to Reoperation: 1,274 (2%)
    2. Connects to No Reoperation: N=59,816 (98%)
  2. Patients who had cancer surgery:
    • Breast N=33,527
    • Bladder N= 1,277
    • Colorectal N=12,941
    • Prostate N=4,909
    • Thyroid N=8,436
      1. Connects to Reoperation:
        • Breast N=390 (1%)
        • Bladder N=94 (7%)
        • Colorectal N=646 (5%)
        • Prostate N=49 (1%)
        • Thyroid N=95 (1%)
      2. Connects to No Reoperation:
        • Breast N=33,137 (99%)
        • Bladder N=1,183 (93%)
        • Colorectal N=12,295 (95%)
        • Prostate N=4,860 (99%)
        • Thyroid N=8,341 (99%)

What do the results show?

Measure:  Percentage of reoperations after cancer surgery for patients diagnosed with bladder, breast, colorectal, prostate and thyroid cancer

 

Desired Direction:

 

An image of an arrow pointing downwards. This indicates that desired direction for this action is downwards.

 

As of this Report:

 

An image of a grey box. This indicates that there is no time trend and this action does not have identified targets.

Among patients who underwent lung surgery for a lobectomy or bilobectomy, 2% had an unplanned reoperation after cancer surgery (Figures 1 and 2).

  • Patients described in these figures include those who had lobectomies or bilobectomies.
  • Among the patients who underwent lobectomies or bilobectomies from fiscal year 2015/2016 to fiscal year 2016/17, 2% had a reoperation after cancer surgery.
  • Reoperation rates for lobectomy or bilobectomy patients varied between designated thoracic surgery centres, ranging from 0% to 5%. This indicates low reoperation rates for this patient population.

About 2% of patients who had bladder, breast, colorectal, prostate or thyroid cancer surgery underwent an unplanned reoperation (Figures 3 and 4).

  • Among the patients who underwent breast, prostate or thyroid cancer surgery from fiscal year 2015/2016 to fiscal year 2016/2017, 1% had a reoperation within 30 days.
  • Among the patients who had bladder cancer surgery during the same period, 7% had an unplanned reoperation after surgery. Among patients who had colorectal cancer surgery, 5% underwent a reoperation during the same period.
  • There is some variation in the reoperation rates for all cancer surgery disease sites among regions.

The number of reoperations after cancer surgery can be broken down by the number of cases per disease site (Figure 5).

  • From fiscal year 2015/16 to fiscal year 2016/17, the total number of reoperations for prostate cancer within Ontario was the lowest among the disease sites, with 49 reoperations. Colorectal cancer was the highest with 646.
  • Additionally, there were a total of 94 reoperations for bladder cancer, 390 for breast cancer and 95 for thyroid cancer.

Why is this important to patient care?

  • Reoperation rate is a surrogate measure for assessing complications following cancer surgery. Monitoring reoperation rates is a measure of surgical quality of cancer care.
  • Monitoring reoperation rates also highlights the increased cost to the healthcare system from these unplanned procedures.

Find out more:

Notes

  1. Kroon HM, Breslau PJ, Lardenoye JWH. Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery? Am J Med Qual. 2007;22(3):198–202.