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National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA
  1. Shyam Sukumar1,
  2. Florian Roghmann2,3,
  3. Vincent Q Trinh2,
  4. Jesse D Sammon1,
  5. Mai-Kim Gervais4,
  6. Hung-Jui Tan5,
  7. Praful Ravi1,
  8. Simon P Kim6,
  9. Jim C Hu7,
  10. Pierre I Karakiewicz2,
  11. Joachim Noldus3,
  12. Maxine Sun2,
  13. Mani Menon1,
  14. Quoc-Dien Trinh2,8
  1. 1Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, Michigan, USA
  2. 2Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
  3. 3Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany
  4. 4Division of General Surgery, University of Montreal Health Center, Montreal, Canada
  5. 5Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, USA
  6. 6Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
  7. 7Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  8. 8Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Florian Roghmann; f.roghmann{at}


Objectives While multiple studies have demonstrated variations in the quality of cancer care in the USA, payers are increasingly assessing structure-level and process-level measures to promote quality improvement. Hospital-acquired adverse events are one such measure and we examine their national trends after major cancer surgery.

Design Retrospective, cross-sectional analysis of a weighted-national estimate from the Nationwide Inpatient Sample (NIS) undergoing major oncological procedures (colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy and prostatectomy). The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were utilised to identify trends in hospital-acquired adverse events.

Setting Secondary and tertiary care, US hospitals in NIS

Participants A weighted-national estimate of 2 508 917 patients (>18 years, 1999–2009) from NIS.

Primary outcome measures Hospital-acquired adverse events.

Results 324 852 patients experienced ≥1-PSI event (12.9%). Patients with ≥1-PSI experienced higher rates of in-hospital mortality (OR 19.38, 95% CI 18.44 to 20.37), prolonged length of stay (OR 4.43, 95% CI 4.31 to 4.54) and excessive hospital-charges (OR 5.21, 95% CI 5.10 to 5.32). Patients treated at lower volume hospitals experienced both higher PSI events and failure-to-rescue rates. While a steady increase in the frequency of PSI events after major cancer surgery has occurred over the last 10 years (estimated annual % change (EAPC): 3.5%, p<0.001), a concomitant decrease in failure-to-rescue rates (EAPC −3.01%) and overall mortality (EAPC −2.30%) was noted (all p<0.001).

Conclusions Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required.

  • Patient Safety Indicators
  • Cancer surgery
  • Preventable Adverse Events
  • Patient Safety Indicators
  • Quality Improvement

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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